Basic Information
| Provider Information | |||||||||
| NPI: | 1972173508 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRALICEK | ||||||||
| FirstName: | KATHERINE | ||||||||
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| Credential: | MOT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5106 W 156TH ST | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662243521 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7000 W 121ST ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | LEAWOOD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662092011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9139122174 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2021 | ||||||||
| LastUpdateDate: | 06/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | T-05586 | KS | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.