Healthcare Provider Details

I. General information

NPI: 1083824726
Provider Name (Legal Business Name): HOWARD MICHAEL KRAVITZ D.O., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RUSH UNIVERSITY MEDICAL CENTER 1653 WEST CONGRESS PARKWAY
CHICAGO IL
60612-3833
US

IV. Provider business mailing address

4235 ENFIELD AVE
SKOKIE IL
60076-1950
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-4161
  • Fax: 312-942-6216
Mailing address:
  • Phone: 312-942-4161
  • Fax: 312-942-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036-055037
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number036-055037
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number036-055037
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: