Provider Demographics
NPI:1336992684
Name:KRANICK, MATTHEW BROKAW (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BROKAW
Last Name:KRANICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 E 19TH ST
Mailing Address - Street 2:KRAVIS BUILDING
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1802 E 19TH ST
Practice Address - Street 2:KRAVIS BUILDING
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5403
Practice Address - Country:US
Practice Address - Phone:918-634-7500
Practice Address - Fax:918-634-7560
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program