=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467512954
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DONALD KRATZ MD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2006
-----------------------------------------------------
Last Update Date | 06/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1317 W BROADWAY
-----------------------------------------------------
City | BOLIVAR
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-777-4331
-----------------------------------------------------
Fax | 417-777-5064
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 880 E. SAN MARTIN
-----------------------------------------------------
City | BOLIVAR
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-777-4331
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DONALD P KRATZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 417-887-5500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------