Healthcare Provider Details

I. General information

NPI: 1598042657
Provider Name (Legal Business Name): JEROME P. KRALKA I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JERRY KRALKA

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 MEADOWBROOK ST
LAKE DALLAS TX
75065-2312
US

IV. Provider business mailing address

514 MEADOWBROOK ST
LAKE DALLAS TX
75065-2312
US

V. Phone/Fax

Practice location:
  • Phone: 940-765-1111
  • Fax:
Mailing address:
  • Phone: 940-765-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: