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General NPI Number Information
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NPI Number | 1013375062
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Entity Type | Organization
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Legal Business Name | KRAVITZ PHYSICIAN SERVICES, P.A.
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Dates
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Enumeration Date | 02/05/2016
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Last Update Date | 02/05/2016
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Provider Practice Location Address
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Address Line | 5150 NW 82ND TER
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-2811
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Country | US
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Telephone | 754-702-5348
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Fax | 954-755-2830
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Provider Business Mailing Address
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Address Line | 5150 NW 82ND TER
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-2811
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Country | US
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Telephone | 754-702-5348
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Fax | 954-755-2830
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACK ALLAN KRAVITZ
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Credential | M.D.
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Telephone | 754-702-5348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | ME41286
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License Number State | FL
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