Provider Demographics
NPI:1013375062
Name:KRAVITZ PHYSICIAN SERVICES, P.A.
Entity Type:Organization
Organization Name:KRAVITZ PHYSICIAN SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:KRAVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:754-702-5348
Mailing Address - Street 1:5150 NW 82ND TER
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2811
Mailing Address - Country:US
Mailing Address - Phone:754-702-5348
Mailing Address - Fax:954-755-2830
Practice Address - Street 1:5150 NW 82ND TER
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-2811
Practice Address - Country:US
Practice Address - Phone:754-702-5348
Practice Address - Fax:954-755-2830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41286207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty