Provider Demographics
NPI:1386686012
Name:KRAVETS, SERGEI A (MD)
Entity Type:Individual
Prefix:
First Name:SERGEI
Middle Name:A
Last Name:KRAVETS
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 1:330 MADISON ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6565
Mailing Address - Country:US
Mailing Address - Phone:815-725-3440
Mailing Address - Fax:815-725-7209
Practice Address - Street 1:330 MADISON ST
Practice Address - Street 2:SUITE 104
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6565
Practice Address - Country:US
Practice Address - Phone:815-725-3440
Practice Address - Fax:815-725-7209
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036093445Medicaid
IL1932141579Medicare NSC
ILL58075Medicare PIN
G79948Medicare UPIN