Provider Demographics
NPI:1437158847
Name:KRAVITZ, EDWARD CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:CHARLES
Last Name:KRAVITZ
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:PO BOX 7054
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-7054
Mailing Address - Country:US
Mailing Address - Phone:714-571-5000
Mailing Address - Fax:714-571-5055
Practice Address - Street 1:302 W LA VETA AVE
Practice Address - Street 2:STE. 203
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2607
Practice Address - Country:US
Practice Address - Phone:714-835-4404
Practice Address - Fax:714-532-6563
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC26238207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C262380Medicaid
A33077Medicare UPIN
C26238Medicare ID - Type Unspecified