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NPI Code Detail

MEDICARE: KEVIN JOSEPH GANCARCZYK M.D.

MEDICARE: KEVIN JOSEPH GANCARCZYK M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208800000XUrology Physician26830OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013983741
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN JOSEPH GANCARCZYK M.D.
Provider Business Mailing Address
First Line : 10901 E 48TH ST
Second Line :
City : TULSA
State : OK
Zip : 74146-5830
Country : US
Telephone Number : 918-749-8765
Fax Number : 918-392-2155
Provider Business Practice Location Address
First Line : 10901 E 48TH ST
Second Line :
City : TULSA
State : OK
Zip : 74146-5830
Country : US
Telephone Number : 918-749-8765
Fax Number : 918-392-2155
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2006
Last Update Date : 07/05/2022

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