Basic Information
| Provider Information | |||||||||
| NPI: | 1124181748 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRALOVICH | ||||||||
| FirstName: | KURT | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 FRANK LLOYD WRIGHT DR | ||||||||
| Address2: | PO BOX 0446 LOBBY J | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347476766 | ||||||||
| FaxNumber: | 8107600440 | ||||||||
| Practice Location | |||||||||
| Address1: | 5301 E. HURON RIVER DR. | ||||||||
| Address2: | |||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347127017 | ||||||||
| FaxNumber: | 7347122844 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0127X | 4301056548 | MI | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 2086S0102X | 4301056548 | MI | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
ID Information
| ID | Type | State | Issuer | Description | 327165110 | 05 | MI | MEDICAID | KK056548 | 01 | COMMERCIAL-COMMERCIAL NUMBER | OTHER | 700H262310 | 01 | BLUE CROSS-BLUE CROSS | OTHER | KK056548 | 01 | CHAMPUS-CHAMPUS | OTHER |