Provider Demographics
NPI:1225142920
Name:KRATZ, KURT GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:GREGORY
Last Name:KRATZ
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 1:5052 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1069
Mailing Address - Country:US
Mailing Address - Phone:601-261-2587
Mailing Address - Fax:601-261-3201
Practice Address - Street 1:5052 W 4TH ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1069
Practice Address - Country:US
Practice Address - Phone:601-261-2587
Practice Address - Fax:601-261-3201
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13985207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114534Medicaid
MSC02413OtherMEDICARE GROUP
MS220024431OtherRAILROAD MEDICARE
MS1130027OtherUNITED HEALTHCARE
MS09014846OtherMEDICAID GROUP
LA1152501OtherLOUISIANNA MEDICAID
MSF28972Medicare UPIN
MS00114534Medicaid