Basic Information
| Provider Information | |||||||||
| NPI: | 1467450692 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KREHBIEL | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14024 QUAIL POINTE DR | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731341006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054198420 | ||||||||
| FaxNumber: | 4054197745 | ||||||||
| Practice Location | |||||||||
| Address1: | 2117 N. KELLY AVE. | ||||||||
| Address2: | |||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730033908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057262701 | ||||||||
| FaxNumber: | 4057262702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 03/12/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 18489 | OK | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 18489 | OK | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | P00091305 | 01 | RAILROAD MEDICARE | OTHER | 100136830D | 05 | OK | MEDICAID |