Provider Demographics
NPI:1114919180
Name:EDWARD C. KRAVITZ, M.D., INCORPORATED
Entity Type:Organization
Organization Name:EDWARD C. KRAVITZ, M.D., INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:KRAVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-835-4404
Mailing Address - Street 1:PO BOX 7054
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-7054
Mailing Address - Country:US
Mailing Address - Phone:714-571-5000
Mailing Address - Fax:714-571-5055
Practice Address - Street 1:302 W LA VETA AVE
Practice Address - Street 2:STE. 201
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2607
Practice Address - Country:US
Practice Address - Phone:714-835-4404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty