# CRESTCARE FAMILY MEDICINE,PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174139554
- **Authorized official:** DR. GAURANGI M ANKLESARIA MD (OWNER)
- **Authorized official phone:** (918) 251-9698

## Contact information

- **Practice address:** 817 S ELM PL STE 104, BROKEN ARROW, OK 74012-5369
- **Practice address phone:** (918) 251-9698
- **Practice address fax:** (405) 241-9022
- **Mailing address:** 817 S ELM PL STE 104, BROKEN ARROW, OK 74012-5369
- **Mailing address phone:** (918) 251-9698
- **Mailing address fax:** (405) 241-9022

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/21/2020
- **Last updated:** 09/21/2020