Provider Demographics
NPI:1922482736
Name:JILL CAROLE KRANZOW DPM PA
Entity Type:Organization
Organization Name:JILL CAROLE KRANZOW DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:C
Authorized Official - Last Name:WISDOM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:972-769-7280
Mailing Address - Street 1:6309 PRESTON RD STE 1200
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2741
Mailing Address - Country:US
Mailing Address - Phone:972-769-7280
Mailing Address - Fax:972-769-7287
Practice Address - Street 1:8080 STATE HIGHWAY 121
Practice Address - Street 2:SUITE 200
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2900
Practice Address - Country:US
Practice Address - Phone:972-769-7280
Practice Address - Fax:972-769-7287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1283213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty