Provider Demographics
NPI:1720054547
Name:KRANTZ, ALAN G (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALAN
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 1:400 WEST ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4170
Mailing Address - Country:US
Mailing Address - Phone:508-587-9500
Mailing Address - Fax:508-580-6869
Practice Address - Street 1:400 WEST ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4170
Practice Address - Country:US
Practice Address - Phone:508-587-9500
Practice Address - Fax:508-580-6869
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1569213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2315920OtherUS HEALTHCARE
2701021OtherUNITED HEALTHCARE
MA33012OtherPILGRIM
MA702679OtherTUFTS HEALTHPLAN
B70031301OtherCIGNA
MAAL Y77100OtherBLUE SHIELD
S021908OtherCHAMPUS
MAKY Y70664OtherBLUE SHIELD INDIVIDUAL #
2315920OtherUS HEALTHCARE
MAKY Y70664OtherBLUE SHIELD INDIVIDUAL #