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NPI Code Detail

MEDICARE: PETER ALLAN IPPOLITI

MEDICARE: PETER ALLAN IPPOLITI
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1619750015
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER ALLAN IPPOLITI
Provider Business Mailing Address
First Line : 4904 S KNOXVILLE PL
Second Line :
City : TULSA
State : OK
Zip : 74135-3112
Country : US
Telephone Number : 405-880-8046
Fax Number :
Provider Business Practice Location Address
First Line : 4904 S KNOXVILLE PL
Second Line :
City : TULSA
State : OK
Zip : 74135-3112
Country : US
Telephone Number : 405-880-8046
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2023
Last Update Date : 08/17/2023

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Directions to “ PETER ALLAN IPPOLITI ” Practice Location

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