MEDICARE: JOHN E STECKLOW M.D

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	2080A0000X	Pediatric Adolescent Medicine Physician	20247	OK

General Provider Information

NPI Number	:	1457462574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN E STECKLOW M.D

Provider Business Mailing Address
First Line	:	3613 NW 56TH ST
Second Line	:	SUITE 320
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4526
Country	:	US
Telephone Number	:	405-949-5505
Fax Number	:	405-949-0718

Provider Business Practice Location Address
First Line	:	3613 NW 56TH ST
Second Line	:	SUITE 320
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4526
Country	:	US
Telephone Number	:	405-949-5505
Fax Number	:	405-949-0718

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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Directions to “ JOHN E STECKLOW M.D” Practice Location

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