Healthcare Provider Details

I. General information

NPI: 1912593203
Provider Name (Legal Business Name): SHADRICK KRALIK MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2198 MAIN ST
SARASOTA FL
34237-6024
US

IV. Provider business mailing address

2198 MAIN ST
SARASOTA FL
34237-6024
US

V. Phone/Fax

Practice location:
  • Phone: 941-315-9155
  • Fax: 727-674-1317
Mailing address:
  • Phone: 941-315-9155
  • Fax: 727-674-1317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SHADRICK KRALIK
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 941-315-9155