MEDICARE: EDWARD CHARLES KRAVITZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	C26238	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437158847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD CHARLES KRAVITZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 7054
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92863-7054
Country	:	US
Telephone Number	:	714-571-5000
Fax Number	:	714-571-5055

Provider Business Practice Location Address
First Line	:	302 W LA VETA AVE
Second Line	:	STE. 203
City	:	ORANGE
State	:	CA
Zip	:	92866-2607
Country	:	US
Telephone Number	:	714-835-4404
Fax Number	:	714-532-6563

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	08/18/2008

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