MEDICARE: UROLOGY SPECIALISTS OF CENTRAL OKLAHOMA

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	208800000X	Urology Physician		OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356612063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UROLOGY SPECIALISTS OF CENTRAL OKLAHOMA

Provider Business Mailing Address
First Line	:	5401 N. PORTLAND AVE. SUITE 440
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112
Country	:	US
Telephone Number	:	405-943-1137
Fax Number	:	405-947-0731

Provider Business Practice Location Address
First Line	:	5401 N. PORTLAND AVE. SUITE 440
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112
Country	:	US
Telephone Number	:	405-943-1137
Fax Number	:	405-947-0731

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	EN SHEA SAMARA
Credential	:	MD
Telephone Number	:	405-943-1137

Provider Enumeration Date	:	01/26/2012
Last Update Date	:	02/17/2026

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