MEDICARE: STEPHEN TKACH 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	207X00000X	Orthopaedic Surgery Physician	820P	OK

General Provider Information

NPI Number	:	1700884087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN TKACH M.D.

Provider Business Mailing Address
First Line	:	3056 BRUSH CREEK RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-1856
Country	:	US
Telephone Number	:	405-751-3515
Fax Number	:

Provider Business Practice Location Address
First Line	:	3056 BRUSH CREEK RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-1856
Country	:	US
Telephone Number	:	405-751-3515
Fax Number	:

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	02/22/2016

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