Healthcare Provider Details

I. General information

NPI: 1336101591
Provider Name (Legal Business Name): KEITH A KREITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 DUPLIN STREET
KENANSVILLE NC
28349-9024
US

IV. Provider business mailing address

211 DUPLIN STREET
KENANSVILLE NC
28341-9024
US

V. Phone/Fax

Practice location:
  • Phone: 910-275-0027
  • Fax: 910-296-0214
Mailing address:
  • Phone: 910-275-0027
  • Fax: 910-296-0214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD430162
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number15775R
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2023-02847
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: