Healthcare Provider Details

I. General information

NPI: 1194825281
Provider Name (Legal Business Name): DONALD KRATZ MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 W BROADWAY
BOLIVAR MO
65613
US

IV. Provider business mailing address

1135 E LAKEWOOD SUITE 112
SPRINGFIELD MO
65810
US

V. Phone/Fax

Practice location:
  • Phone: 417-777-4331
  • Fax: 417-777-5064
Mailing address:
  • Phone: 417-887-5500
  • Fax: 417-883-8694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DONALD P KRATZ
Title or Position: PRESIDENT
Credential: MD
Phone: 417-887-5500