Provider Demographics
NPI:1467461558
Name:KRATT, LOGAN FREDERICK (MD)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:FREDERICK
Last Name:KRATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17067 S OUTER RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-2165
Mailing Address - Country:US
Mailing Address - Phone:816-331-4000
Mailing Address - Fax:
Practice Address - Street 1:17067 S OUTER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-2165
Practice Address - Country:US
Practice Address - Phone:816-331-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010028280207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1467461558Medicaid
MOP14000004Medicare Oscar/Certification