Provider Demographics
NPI:1215073705
Name:INTERNAL MEDICINE GROUP PC
Entity type:Organization
Organization Name:INTERNAL MEDICINE GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:KRANZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-635-4141
Mailing Address - Street 1:7212 COMMONS CIR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-2667
Mailing Address - Country:US
Mailing Address - Phone:307-635-4141
Mailing Address - Fax:307-635-6587
Practice Address - Street 1:7212 COMMONS CIR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-2667
Practice Address - Country:US
Practice Address - Phone:307-635-4141
Practice Address - Fax:307-635-6587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106240900Medicaid
WY303538Medicare ID - Type Unspecified
WY490001961Medicare PIN