Healthcare Provider Details

I. General information

NPI: 1902078686
Provider Name (Legal Business Name): STEPHEN FRANCIS KRALIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N SENATE BLVD RADIOLOGY DEPARTMENT
INDIANAPOLIS IN
46202
US

IV. Provider business mailing address

6701 FANNIN ST STE 470
HOUSTON TX
77030-2608
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-5740
  • Fax:
Mailing address:
  • Phone: 832-824-7237
  • Fax: 832-825-0160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number01062163A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01062163A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberR8033
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: