MEDICARE: KREITZBERG PLASTIC SURGERY LLC

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	2086S0122X	Plastic and Reconstructive Surgery Physician

General Provider Information

NPI Number	:	1699390963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KREITZBERG PLASTIC SURGERY LLC

Provider Business Mailing Address
First Line	:	8010 S 101ST EAST AVE STE 100
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-4562
Country	:	US
Telephone Number	:	918-940-4700
Fax Number	:	303-557-6216

Provider Business Practice Location Address
First Line	:	8010 S 101ST EAST AVE STE 100
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-4562
Country	:	US
Telephone Number	:	918-940-4700
Fax Number	:	303-557-6216

Authorized Official
Title or Position	:	DO/OWNER
Name	:	SCOTT A KREITZBERG
Credential	:	DO
Telephone Number	:	918-940-4700

Provider Enumeration Date	:	06/12/2020
Last Update Date	:	07/13/2021

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