Provider Demographics
NPI:1225298979
Name:CRAIGE M BRESTEL MD PLLC
Entity Type:Organization
Organization Name:CRAIGE M BRESTEL MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIGE
Authorized Official - Middle Name:MONTANE
Authorized Official - Last Name:BRESTEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-687-5477
Mailing Address - Street 1:3401 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-2136
Mailing Address - Country:US
Mailing Address - Phone:918-687-5477
Mailing Address - Fax:918-687-0684
Practice Address - Street 1:3401 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-2136
Practice Address - Country:US
Practice Address - Phone:918-687-5477
Practice Address - Fax:918-687-0684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19912207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200317890AMedicaid
OK200317890BMedicaid