Provider Demographics
NPI:1588609903
Name:KRANTZ, LELAND K II (MD)
Entity Type:Individual
Prefix:DR
First Name:LELAND
Middle Name:K
Last Name:KRANTZ
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2001 S WOODRUFF AVE
Mailing Address - Street 2:SUITE #15
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6374
Mailing Address - Country:US
Mailing Address - Phone:208-522-7310
Mailing Address - Fax:208-524-0559
Practice Address - Street 1:2001 S WOODRUFF AVE
Practice Address - Street 2:SUITE #15
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6374
Practice Address - Country:US
Practice Address - Phone:208-522-7310
Practice Address - Fax:208-524-0559
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM3620207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010004088OtherREGENCE BLUE SHIELD
ID3620-2OtherBLUE CROSS
IDMD1942OtherIDAHO STATE NARC. #
IDMD1942OtherIDAHO STATE NARC. #
IDE07049Medicare UPIN
ID3620-2OtherBLUE CROSS