Provider Demographics
NPI:1003886755
Name:KRAJCIK, ROBERT JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:KRAJCIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29325 HEALTH CAMPUS DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-8201
Mailing Address - Country:US
Mailing Address - Phone:440-414-9400
Mailing Address - Fax:440-808-3618
Practice Address - Street 1:29325 HEALTH CAMPUS DR
Practice Address - Street 2:SUITE 3
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-8201
Practice Address - Country:US
Practice Address - Phone:440-414-9400
Practice Address - Fax:440-808-3618
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHF51744OtherSUMMA
080144353OtherRAILROAD MEDICARE
OH000000128716OtherANTHEM
OH0603118Medicaid
OHKR0878932Medicare ID - Type Unspecified
D69034Medicare UPIN