Provider Demographics
NPI:1922112952
Name:ALAN E KRAVITZ MD INC
Entity Type:Organization
Organization Name:ALAN E KRAVITZ MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KRAVITZ
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:440-995-4000
Mailing Address - Street 1:29001 CEDAR RD
Mailing Address - Street 2:#615
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4062
Mailing Address - Country:US
Mailing Address - Phone:440-995-4000
Mailing Address - Fax:440-995-4023
Practice Address - Street 1:29001 CEDAR RD
Practice Address - Street 2:#615
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-4062
Practice Address - Country:US
Practice Address - Phone:440-995-4000
Practice Address - Fax:440-995-4023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-038909207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000128649OtherANTHEM PROVIDER#
OH142321733001OtherMEDICAL MUTUAL PROVIDER#
OH35-035909OtherMEDICAL LICENSE #
OH0298549Medicaid
OH0298549Medicaid
OH35-035909OtherMEDICAL LICENSE #
OH0298549Medicaid
OHA75486Medicare UPIN