Provider Demographics
NPI:1699390963
Name:KREITZBERG PLASTIC SURGERY LLC
Entity type:Organization
Organization Name:KREITZBERG PLASTIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:KREITZBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-940-4700
Mailing Address - Street 1:8010 S 101ST EAST AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4562
Mailing Address - Country:US
Mailing Address - Phone:918-940-4700
Mailing Address - Fax:303-557-6216
Practice Address - Street 1:8010 S 101ST EAST AVE STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4562
Practice Address - Country:US
Practice Address - Phone:918-940-4700
Practice Address - Fax:303-557-6216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-12
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty