Provider Demographics
NPI:1619080736
Name:KRADEL, JOSEPH C (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:C
Last Name:KRADEL
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 1:2907 E JOYCE BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5011
Mailing Address - Country:US
Mailing Address - Phone:479-442-9900
Mailing Address - Fax:479-442-9903
Practice Address - Street 1:2907 E JOYCE BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5011
Practice Address - Country:US
Practice Address - Phone:479-442-9900
Practice Address - Fax:479-442-9903
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1183207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5K345OtherBX INDIVIDUAL PROVIDER #
AR130872001Medicaid
ARG42171Medicare UPIN
AR130872001Medicaid