Provider Demographics
NPI:1952323446
Name:KRAVETZ, MICHAEL L (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:KRAVETZ
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 1:13460 N 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1000
Mailing Address - Country:US
Mailing Address - Phone:623-878-8800
Mailing Address - Fax:623-878-5254
Practice Address - Street 1:13460 N 67TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1000
Practice Address - Country:US
Practice Address - Phone:623-878-8800
Practice Address - Fax:623-878-5254
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20238208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0895230OtherBLUE CROSS BLUE SHIELD
AZ048406Medicaid
E96466Medicare UPIN
AZ6900Medicare PIN