Provider Demographics
NPI:1346443868
Name:ALAN G. KRANTZ, D.P.M., P.C.
Entity Type:Organization
Organization Name:ALAN G. KRANTZ, D.P.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:KRANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:508-587-9500
Mailing Address - Street 1:400 WEST ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4170
Mailing Address - Country:US
Mailing Address - Phone:508-587-9500
Mailing Address - Fax:508-580-6869
Practice Address - Street 1:400 WEST ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4170
Practice Address - Country:US
Practice Address - Phone:508-587-9500
Practice Address - Fax:508-580-6869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1569213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY77100OtherBLUE SHIELD GROUP
MAY77100OtherBLUE SHIELD GROUP
MA0724090001Medicare NSC