Provider Demographics
NPI:1649536228
Name:KRANTZ, TESSA E (MD)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:E
Last Name:KRANTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21414 W DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1144
Mailing Address - Country:US
Mailing Address - Phone:305-965-0500
Mailing Address - Fax:954-416-7538
Practice Address - Street 1:21414 W DIXIE HWY
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1144
Practice Address - Country:US
Practice Address - Phone:305-965-0500
Practice Address - Fax:954-416-7538
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-08
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2019-0742207VF0040X
390200000X
NM390200000X
FLME130860207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program