MEDICARE: AKY MD LLC

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	305R00000X	Preferred Provider Organization	103749	OK

General Provider Information

NPI Number	:	1568852135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AKY MD LLC

Provider Business Mailing Address
First Line	:	2809 SW 119TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-2605
Country	:	US
Telephone Number	:	405-757-7818
Fax Number	:

Provider Business Practice Location Address
First Line	:	2809 SW 119TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-2605
Country	:	US
Telephone Number	:	405-757-7818
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ALEX YAFFE
Credential	:
Telephone Number	:	405-757-7818

Provider Enumeration Date	:	02/03/2015
Last Update Date	:	02/03/2015

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Directions to “AKY MD LLC ” Practice Location

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