Provider Demographics
NPI:1861458861
Name:KRALOVIC, STEPHEN
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:KRALOVIC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636256
Mailing Address - Street 2:CENTRAL CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-5504
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:3223 EDEN & ALBERT SABIN
Practice Address - Street 2:#405
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-0405
Practice Address - Country:US
Practice Address - Phone:513-584-6868
Practice Address - Fax:513-584-6040
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-061094207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200218140Medicaid
KY64953441Medicaid
OH0316849Medicaid
OH440002871OtherRAIL ROAD MEDICARE
OHKR0813171Medicare PIN
KY64953441Medicaid