MEDICARE: STEPHEN M. ACKERLEY 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	207XS0106X	Orthopaedic Hand Surgery Physician	22311	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	:	1891778767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN M. ACKERLEY M.D.

Provider Business Mailing Address
First Line	:	6585 S YALE AVE
Second Line	:	SUITE 200
City	:	TULSA
State	:	OK
Zip	:	74136-8384
Country	:	US
Telephone Number	:	918-481-2767
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 HONOR HEIGHTS DR
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74401-1318
Country	:	US
Telephone Number	:	918-577-3000
Fax Number	:

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	12/06/2024

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