MEDICARE: JOHN K BINI MD

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	208600000X	Surgery Physician	M0664	TX
2	2086S0102X	Surgical Critical Care Physician	34066	OK
3	2086S0127X	Trauma Surgery Physician	35.122564	OH
4	2086S0127X	Trauma Surgery Physician	34066	OK
5	208600000X	Surgery Physician	34066	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861515165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN K BINI MD

Provider Business Mailing Address
First Line	:	1200 W CHEROKEE ST
Second Line	:
City	:	WAGONER
State	:	OK
Zip	:	74467-4624
Country	:	US
Telephone Number	:	918-485-5514
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 W CHEROKEE ST STE C
Second Line	:
City	:	WAGONER
State	:	OK
Zip	:	74467-4629
Country	:	US
Telephone Number	:	918-485-1205
Fax Number	:	918-485-1695

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	09/01/2022

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Directions to “ JOHN K BINI MD” Practice Location

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