Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 5101019676 | MI |
N | 208600000X | Surgeon | 5101019676 | MI |
N | 208200000X | Surgeon | 5315085034 | MI |
N | 208600000X | Surgeon | 5315085034 | MI |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 6831 | OK |
NPI | 1225397797 |
---|---|
Provider Name | Scott A Kreitzberg |
First Address | Tulsa, OK 74133-4562 |
Second Address | Tulsa, OK 74133-4562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2012 |
Last Update Date | 13/07/2021 |