Provider Demographics
NPI:1497762280
Name:BRESTEL, CRAIGE M (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIGE
Middle Name:M
Last Name:BRESTEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:918-682-5477
Mailing Address - Fax:918-687-5481
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:918-682-5477
Practice Address - Fax:918-687-5481
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19912207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100033120AMedicaid
OK100729650AMedicaid
F05230Medicare UPIN