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NPI Code Detail

MEDICARE: WINROD YACKESCHI RED ELK

MEDICARE: WINROD YACKESCHI RED ELK
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
1175T00000XPeer Specialist

General Provider Information

NPI Number : 1548800907
Entity Type Code : Individual
Provider Name (Legal Business Name) : WINROD YACKESCHI RED ELK
Provider Business Mailing Address
First Line : 8501 NW MADISCHE RD
Second Line :
City : LAWTON
State : OK
Zip : 73507-1221
Country : US
Telephone Number : 580-492-3614
Fax Number :
Provider Business Practice Location Address
First Line : 8501 NW MADISCHE RD
Second Line :
City : LAWTON
State : OK
Zip : 73507-1221
Country : US
Telephone Number : 580-492-3614
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2020
Last Update Date : 01/13/2020

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Directions to “ WINROD YACKESCHI RED ELK ” Practice Location

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