Provider Demographics
NPI:1326197344
Name:KRATZ, ROBERT
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:KRATZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 LAKE BOONE TRL
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7503
Mailing Address - Country:US
Mailing Address - Phone:919-861-9777
Mailing Address - Fax:919-861-9776
Practice Address - Street 1:4601 LAKE BOONE TRL
Practice Address - Street 2:SUITE 1D
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7503
Practice Address - Country:US
Practice Address - Phone:919-861-9777
Practice Address - Fax:919-861-9776
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000-21987207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC50291OtherBCNC
NC50291OtherBCNC
NC8950291Medicare ID - Type Unspecified
C69612Medicare ID - Type Unspecified