Provider Demographics
NPI:1225020035
Name:KRODEL, JOHN M (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:KRODEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:950 N PORTER AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6400
Mailing Address - Country:US
Mailing Address - Phone:405-329-0121
Mailing Address - Fax:405-292-6099
Practice Address - Street 1:950 N PORTER AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6400
Practice Address - Country:US
Practice Address - Phone:405-329-0121
Practice Address - Fax:405-292-6099
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK18046207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK110110801OtherRAILROAD MEDICARE
OK100125950AMedicaid
OK4645708OtherAETNA EDI
OK110110801OtherRAILROAD MEDICARE