Provider Demographics
NPI:1326044652
Name:KRAVITZ, ROBIN DALE (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:DALE
Last Name:KRAVITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 CHATHAM LN
Mailing Address - Street 2:SUITE 215
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2416
Mailing Address - Country:US
Mailing Address - Phone:614-457-3894
Mailing Address - Fax:614-457-5698
Practice Address - Street 1:941 CHATHAM LN
Practice Address - Street 2:SUITE 215
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2416
Practice Address - Country:US
Practice Address - Phone:614-457-3894
Practice Address - Fax:614-457-5698
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002713213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0976672Medicaid
OH0976672Medicaid