Provider Demographics
NPI:1659309540
Name:KRAVAT, JEFFREY LANCE (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LANCE
Last Name:KRAVAT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 W STATE ROAD 84 STE B
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4558
Mailing Address - Country:US
Mailing Address - Phone:954-474-5900
Mailing Address - Fax:954-727-9805
Practice Address - Street 1:8600 W STATE ROAD 84 STE B
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4558
Practice Address - Country:US
Practice Address - Phone:954-474-5900
Practice Address - Fax:954-727-9805
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO569213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL87231Medicare ID - Type Unspecified
FL87231AMedicare ID - Type Unspecified
FLT55380Medicare UPIN
FL0907800001Medicare NSC