Provider Demographics
NPI:1568581635
Name:KRATOCHVIL-STAVA, ANGELA JO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:JO
Last Name:KRATOCHVIL-STAVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:JO
Other - Last Name:KRATOCHVIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2123 S 49TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3230
Mailing Address - Country:US
Mailing Address - Phone:402-669-4590
Mailing Address - Fax:
Practice Address - Street 1:982185 NEBRASKA MEDICAL CTR
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-2185
Practice Address - Country:US
Practice Address - Phone:402-888-2561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5464208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics