Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 34008062 | OH |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 34.008062 | OH |
NPI | 1073505806 |
---|---|
Provider Name | Kraig K Solak |
First Address | Chardon, OH 44024-2908 |
Second Address | Chardon, OH 44024-2908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 24/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000527395 | ANTHEM (01) | OH |
2783779 | (05) | OH |
7233660 | AETNA (01) | OH |
I05532 | (02) | OH |
POO436163 | RAILROAD MEDICARE (01) | OH |