Provider Demographics
NPI:1184653289
Name:KRAL, KENNETH J (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
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:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:6420 DUTCHMANS PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3372
Practice Address - Country:US
Practice Address - Phone:502-891-8300
Practice Address - Fax:502-891-8338
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20677207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000044887OtherANTHEM PIN
IN100388640FMedicaid
IN100388640AMedicaid
KY64206774Medicaid
KY1056115OtherPASSPORT PIN
KYP00889588OtherRAILROAD MEDICARE
KY2433839000OtherPASSPORT ADVANTAGE PIN
KY000000044887OtherANTHEM PIN
IN100388640FMedicaid
KY2433839000OtherPASSPORT ADVANTAGE PIN
KY0558403Medicare ID - Type Unspecified
KY0259810Medicare ID - Type Unspecified
KYP00889588OtherRAILROAD MEDICARE
IN100388640AMedicaid
KY1056115OtherPASSPORT PIN