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NPI Code Detail

MEDICARE: DR. ANGELA JO KRATOCHVIL-STAVA M.D.

MEDICARE: DR. ANGELA JO KRATOCHVIL-STAVA M.D.
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
1208000000XPediatrics Physician5464NE

General Provider Information

NPI Number : 1568581635
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANGELA JO KRATOCHVIL-STAVA M.D.
Provider Business Mailing Address
First Line : 2123 S 49TH ST
Second Line :
City : OMAHA
State : NE
Zip : 68106-3230
Country : US
Telephone Number : 402-669-4590
Fax Number :
Provider Business Practice Location Address
First Line : 982185 NEBRASKA MEDICAL CTR
Second Line : DEPARTMENT OF PEDIATRICS
City : OMAHA
State : NE
Zip : 68198-2185
Country : US
Telephone Number : 402-888-2561
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2007
Last Update Date : 07/08/2007

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