Healthcare Provider Details

I. General information

NPI: 1811146632
Provider Name (Legal Business Name): RICK TRACZYK II DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 W MEMORIAL RD STE 909
OKLAHOMA CITY OK
73120-9350
US

IV. Provider business mailing address

PO BOX 960287
OKLAHOMA CITY OK
73196-0001
US

V. Phone/Fax

Practice location:
  • Phone: 405-755-7600
  • Fax:
Mailing address:
  • Phone: 405-755-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: RICK TRACZYK II
Title or Position: OWNER
Credential: DPM
Phone: 405-755-7600