Provider Demographics
NPI:1134100092
Name:KRAL, KEVIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:KRAL
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 1:2065 NE WILLIAMSON CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3867
Mailing Address - Country:US
Mailing Address - Phone:541-383-4191
Mailing Address - Fax:541-317-5848
Practice Address - Street 1:2065 NE WILLIAMSON CT
Practice Address - Street 2:SUITE A
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3867
Practice Address - Country:US
Practice Address - Phone:541-383-4191
Practice Address - Fax:541-317-5848
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16736207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR009253Medicaid
OR009253Medicaid
ORR102620Medicare ID - Type Unspecified