1316948169 NPI number — DR. FRANK DANIEL KRESOCK JR. MD

Table of content: STEPHANIE GRUNE (NPI 1063968840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316948169 NPI number — DR. FRANK DANIEL KRESOCK JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRESOCK
Provider First Name:
FRANK
Provider Middle Name:
DANIEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
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:
1316948169
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1413 W 16TH ST
Provider Second Line Business Mailing Address:
THE CARDIOVASCULAR CENTER
Provider Business Mailing Address City Name:
PARKER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85344-6310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-669-8161
Provider Business Mailing Address Fax Number:
928-669-8171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1413 W 16TH ST
Provider Second Line Business Practice Location Address:
THE CARDIOVASCULAR CENTER
Provider Business Practice Location Address City Name:
PARKER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85344-6310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-669-8161
Provider Business Practice Location Address Fax Number:
928-669-8171
Provider Enumeration Date:
08/02/2005

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: 207RC0000X , with the licence number:  26534 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110161929 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 429698 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: WCSKQ . This is a "SUN HEALTH GRP #" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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