MEDICARE: C. KRALL EXECUTIVE MEDICAL SERVICES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	12574	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12574	OTHER	NV	NEVADA MEDICAL LICENSE

General Provider Information

NPI Number	:	1346495553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C. KRALL EXECUTIVE MEDICAL SERVICES, PLLC

Provider Business Mailing Address
First Line	:	6126 N RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-1408
Country	:	US
Telephone Number	:	702-856-6115
Fax Number	:	702-877-0382

Provider Business Practice Location Address
First Line	:	6126 N RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-1408
Country	:	US
Telephone Number	:	702-856-6115
Fax Number	:	702-877-0382

Authorized Official
Title or Position	:	OWNER
Name	:	CHRIS KRALL
Credential	:	MD
Telephone Number	:	702-856-6115

Provider Enumeration Date	:	12/02/2008
Last Update Date	:	12/02/2008

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