Provider Demographics
NPI:1609869494
Name:TRACZYK, RICHARD JOSEPH II (DPM)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOSEPH
Last Name:TRACZYK
Suffix:II
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:RICK
Other - Middle Name:JOSEPH
Other - Last Name:TRACZYK
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 960287
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196
Mailing Address - Country:US
Mailing Address - Phone:405-755-7600
Mailing Address - Fax:405-755-7680
Practice Address - Street 1:13921 N. MERIDIAN AVENUE
Practice Address - Street 2:SUITE 203
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1104
Practice Address - Country:US
Practice Address - Phone:405-755-7600
Practice Address - Fax:405-755-7680
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK194213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100780360BMedicaid
OK100780360BMedicaid
OK24M802412Medicare PIN
OKU66742Medicare UPIN
OK100780360BMedicaid