Provider Demographics
NPI:1124181748
Name:KRALOVICH, KURT A (MD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:A
Last Name:KRALOVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR
Mailing Address - Street 2:PO BOX 0446 LOBBY J
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:810-760-0440
Practice Address - Street 1:5301 E. HURON RIVER DR.
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-712-7017
Practice Address - Fax:734-712-2844
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010565482086S0127X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI327165110Medicaid
KK056548OtherCOMMERCIAL-COMMERCIAL NUMBER
700H262310OtherBLUE CROSS-BLUE CROSS
KK056548OtherCHAMPUS-CHAMPUS
KK056548OtherCHAMPUS-CHAMPUS
G36147Medicare UPIN