Provider Demographics
NPI:1710912449
Name:KRANTZ, JAMES G (DPM)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:KRANTZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3413
Mailing Address - Country:US
Mailing Address - Phone:203-874-6755
Mailing Address - Fax:
Practice Address - Street 1:32 CHERRY ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3413
Practice Address - Country:US
Practice Address - Phone:203-874-6755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000405213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT480016502OtherRAILROAD MEDICARE PIN
CT0706090003OtherMEDICARE DMERC
CT004069969Medicaid
CT480009818OtherRSILROAD MEDICARE PIN
CT480012075OtherRAILROAD MEDICARE PIN
CT480012075OtherRAILROAD MEDICARE PIN
CT480000307Medicare PIN