Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 4301056548 | MI |
N | 2086S0127X | Trauma Surgeon | 4301056548 | MI |
NPI | 1124181748 |
---|---|
Provider Name | Kurt A Kralovich |
First Address | Ann Arbor, MI 48106 |
Second Address | Ypsilanti, MI 48197 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 23/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
327165110 | (05) | MI |
700H262310 | BLUE CROSS-BLUE CROSS (01) | |
G36147 | (02) | |
KK056548 | CHAMPUS-CHAMPUS (01) | |
KK056548 | COMMERCIAL-COMMERCIAL NUMBER (01) |