MEDICARE: SHAUN H KRETZSCHMAR DO

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
1	207Q00000X	Family Medicine Physician	J9140	TX

General Provider Information

NPI Number	:	1386675502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUN H KRETZSCHMAR DO

Provider Business Mailing Address
First Line	:	317 N FM ROAD 1187
Second Line	:
City	:	ALEDO
State	:	TX
Zip	:	76008-4200
Country	:	US
Telephone Number	:	817-441-7181
Fax Number	:	817-441-7893

Provider Business Practice Location Address
First Line	:	317 N FM ROAD 1187
Second Line	:
City	:	ALEDO
State	:	TX
Zip	:	76008-4200
Country	:	US
Telephone Number	:	817-441-7181
Fax Number	:	817-441-7893

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	08/28/2024

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Directions to “ SHAUN H KRETZSCHMAR DO” Practice Location

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