Basic Information
| Provider Information | |||||||||
| NPI: | 1982642450 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRALIK | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1331 N 7TH ST | ||||||||
| Address2: | STE 375 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027763464 | ||||||||
| FaxNumber: | 6023070080 | ||||||||
| Practice Location | |||||||||
| Address1: | 1331 N 7TH STREET | ||||||||
| Address2: | SUITE 375 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023070070 | ||||||||
| FaxNumber: | 6023070080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 04/28/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 31426 | AZ | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | 31426 | AZ | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 208G00000X | 31426 | AZ | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.