Provider Demographics
NPI:1780786756
Name:KRAVETTE, MARC A (DPM)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:A
Last Name:KRAVETTE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 9TH AVE
Mailing Address - Street 2:MS:M4-PA
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000256213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
480020062OtherRAILROAD MEDICARE
WAUS4350544OtherAETNA/USHC SPECIALIST
WA1501600Medicaid
WAKR5006OtherBLUE SHIELD
WA0039598OtherLABOR & INDUSTRY
WAPD256WAOtherALASKA MEDICAID
T01675Medicare UPIN
WA8852235Medicare PIN
480020062OtherRAILROAD MEDICARE