MEDICARE: DR.JEFFREY LANCE KRAVAT

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	213E00000X	Podiatrist	PO569	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0907800001	OTHER	FL	NSC

General Provider Information

NPI Number	:	1437323938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR.JEFFREY LANCE KRAVAT

Provider Business Mailing Address
First Line	:	8600 W STATE ROAD 84 STE B
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33324-4558
Country	:	US
Telephone Number	:	954-474-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	8600 W STATE ROAD 84 STE B
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33324-4558
Country	:	US
Telephone Number	:	954-474-5900
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFFREY LANCE KRAVAT
Credential	:	DPM
Telephone Number	:	954-474-5900

Provider Enumeration Date	:	04/15/2008
Last Update Date	:	04/15/2008

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