Provider Demographics
NPI:1083697619
Name:KRALL, MICHAEL PATRICK (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PATRICK
Last Name:KRALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 SIR THOMAS COURT
Mailing Address - Street 2:SUITE 7
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-4843
Mailing Address - Country:US
Mailing Address - Phone:717-652-7616
Mailing Address - Fax:717-909-3204
Practice Address - Street 1:845 SIR THOMAS COURT
Practice Address - Street 2:SUITE 7
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-4843
Practice Address - Country:US
Practice Address - Phone:717-652-7616
Practice Address - Fax:717-909-3204
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS011070L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001947118Medicaid
PA001947118Medicaid