Annie D Kraudelt, P.A

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601005402 Issued in MI

Practice address

21031 Michigan Ave
Dearborn, MI 48124-2339

Phone

(313) 277-6700

NPI assigned

Oct 10, 2008

Last updated

Feb 21, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1223596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329782400000",
    "number": "1851542666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4005 ORCHARD DR",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486700001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21031 MICHIGAN AVE",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242339",
            "telephone_number": "313-277-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRAUDELT",
        "first_name": "ANNIE",
        "middle_name": "D",
        "credential": "P.A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-10",
        "last_updated": "2012-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601005402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.