1124181748 NPI number — KURT A KRALOVICH MD

Table of content: KURT A KRALOVICH MD (NPI 1124181748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124181748 NPI number — KURT A KRALOVICH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRALOVICH
Provider First Name:
KURT
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124181748
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 FRANK LLOYD WRIGHT DR
Provider Second Line Business Mailing Address:
PO BOX 0446 LOBBY J
Provider Business Mailing Address City Name:
ANN ARBOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-747-6766
Provider Business Mailing Address Fax Number:
810-760-0440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5301 E. HURON RIVER DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YPSILANTI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48197
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-712-7017
Provider Business Practice Location Address Fax Number:
734-712-2844
Provider Enumeration Date:
12/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0127X , with the licence number:  4301056548 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0102X , with the licence number: 4301056548 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 327165110 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: KK056548 . This is a "COMMERCIAL-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 700H262310 . This is a "BLUE CROSS-BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: KK056548 . This is a "CHAMPUS-CHAMPUS" identifier . This identifiers is of the category "OTHER".




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