Provider Demographics
NPI:1891757878
Name:KOLEGRAFF, RONALD JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JOSEPH
Last Name:KOLEGRAFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:OKOBOJI
Mailing Address - State:IA
Mailing Address - Zip Code:51355-0125
Mailing Address - Country:US
Mailing Address - Phone:712-332-6001
Mailing Address - Fax:712-332-6010
Practice Address - Street 1:1008 EASTVIEW AVE
Practice Address - Street 2:UNIT 8
Practice Address - City:OKOBOJI
Practice Address - State:IA
Practice Address - Zip Code:51355-2633
Practice Address - Country:US
Practice Address - Phone:712-332-6001
Practice Address - Fax:712-332-6010
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24582202K00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0223222Medicaid
IA0223222Medicaid
IAA02582Medicare UPIN