MEDICARE: NEUROLOGICAL SURGERY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician

General Provider Information

NPI Number	:	1063401180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROLOGICAL SURGERY INC

Provider Business Mailing Address
First Line	:	6767 S YALE AVE
Second Line	:	STE A
City	:	TULSA
State	:	OK
Zip	:	74136-3302
Country	:	US
Telephone Number	:	918-492-7587
Fax Number	:	918-491-3542

Provider Business Practice Location Address
First Line	:	6767 S YALE AVE
Second Line	:	STE A
City	:	TULSA
State	:	OK
Zip	:	74136-3302
Country	:	US
Telephone Number	:	918-492-7500
Fax Number	:	918-491-3542

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KARL NORMAN DETWILER
Credential	:	M.D.
Telephone Number	:	918-492-7587

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	07/21/2022

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Directions to “NEUROLOGICAL SURGERY INC ” Practice Location

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