Basic Information
| Provider Information | |||||||||
| NPI: | 1275654386 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRASS | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | LEE RYAN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 COMMONS WAY STE B | ||||||||
| Address2: | |||||||||
| City: | KALISPELL | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599011915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067525170 | ||||||||
| FaxNumber: | 4067525210 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 COMMONS WAY STE B | ||||||||
| Address2: | |||||||||
| City: | KALISPELL | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599011915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067525170 | ||||||||
| FaxNumber: | 4067525210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 5101016883 | MI | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 25806 | MT | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.