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General NPI Number Information
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NPI Number | 1497700041
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Entity Type | Individual
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Provider Name | TODD M. KRAVETZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 523 ROSE LN
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City | WICKENBURG
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State | AZ
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Zip | 85390-1448
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Country | US
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Telephone | 928-668-1833
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Fax | 926-684-7457
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Provider Business Mailing Address
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Address Line | PO BOX 271669
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City | SALT LAKE CITY
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State | UT
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Zip | 84127-1669
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Country | US
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Telephone | 928-684-4383
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Fax | 928-684-2434
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35069162
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 34440
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License Number State | AZ
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