1295833283 NPI number — DR. STEVEN G KRATOVILLE DC

Table of content: DR. STEVEN G KRATOVILLE DC (NPI 1295833283)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295833283 NPI number — DR. STEVEN G KRATOVILLE DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRATOVILLE
Provider First Name:
STEVEN
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1295833283
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1406 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDINA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14103-1822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-798-0328
Provider Business Mailing Address Fax Number:
585-798-0342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1406 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDINA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14103-1822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-798-0328
Provider Business Practice Location Address Fax Number:
585-798-0342
Provider Enumeration Date:
09/21/2006

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: 111N00000X , with the licence number:  X006401-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000225548001 . This is a "BC/BS OF WNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: C06401-6 . This is a "WORKERS COMP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 106040AN . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 161565796 . This is a "PRISM NETWORKS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 350054612 . This is a "MEDICARE RR RET BOARD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 8810832 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7229214 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P010006401 . This is a "BC/BS OF ROCHESTER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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