Healthcare Provider Details

I. General information

NPI: 1811960685
Provider Name (Legal Business Name): MICHAEL LANCE KRALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 WOODLAND STREET SUITE 11
HARTFORD CT
06105
US

IV. Provider business mailing address

19 WOODLAND STREET SUITE 11
HARTFORD CT
06105
US

V. Phone/Fax

Practice location:
  • Phone: 860-246-7273
  • Fax: 860-246-5828
Mailing address:
  • Phone: 860-246-7273
  • Fax: 860-246-5828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number026257
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number026257
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: