Provider Demographics
NPI:1194825281
Name:DONALD KRATZ MD LLC
Entity Type:Organization
Organization Name:DONALD KRATZ MD LLC
Other - Org Name:WOMAN'S CLINIC OF BOLIVAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:KRATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-887-5500
Mailing Address - Street 1:1135 E LAKEWOOD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810
Mailing Address - Country:US
Mailing Address - Phone:417-887-5500
Mailing Address - Fax:417-883-8694
Practice Address - Street 1:1317 W BROADWAY
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613
Practice Address - Country:US
Practice Address - Phone:417-777-4331
Practice Address - Fax:417-777-5064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506186501Medicaid
MO506186501Medicaid