Provider Demographics
NPI:1891931374
Name:RICK TRACZYK II DPM PC
Entity Type:Organization
Organization Name:RICK TRACZYK II DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:TRACZYK
Authorized Official - Suffix:II
Authorized Official - Credentials:DPM
Authorized Official - Phone:405-755-7600
Mailing Address - Street 1:PO BOX 960287
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0001
Mailing Address - Country:US
Mailing Address - Phone:405-755-7600
Mailing Address - Fax:
Practice Address - Street 1:13921 N MERIDIAN AVE STE 203
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1104
Practice Address - Country:US
Practice Address - Phone:405-755-7600
Practice Address - Fax:405-755-7680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-05
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5224280001Medicare NSC