Provider Demographics
NPI:1568721033
Name:KREITZBERG, JESSICA ANN (DO)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:KREITZBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11212 E 48TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-5824
Mailing Address - Country:US
Mailing Address - Phone:918-556-3000
Mailing Address - Fax:918-556-7054
Practice Address - Street 1:11212 E 48TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5824
Practice Address - Country:US
Practice Address - Phone:918-556-3000
Practice Address - Fax:918-556-7054
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6823207RH0003X
MI5101019784207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology