=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740463710
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JILL CAROLE KRANZOW DPM PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2007
-----------------------------------------------------
Last Update Date | 06/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6309 PRESTON RD SUITE 1200
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75024-2606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-769-7280
-----------------------------------------------------
Fax | 972-769-7287
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6309 PRESTON RD SUITE 1200
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75024-2606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-769-7280
-----------------------------------------------------
Fax | 972-769-7287
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JILL C KRANZOW
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 972-769-7280
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 1283
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------