MEDICARE: KAITLIN PAIGE DOMEK

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	208C00000X	Colon & Rectal Surgery Physician	38360	OK

General Provider Information

NPI Number	:	1932595576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN PAIGE DOMEK

Provider Business Mailing Address
First Line	:	6600 S YALE AVE STE 1200
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-3361
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6465 S YALE AVE STE 615
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-7808
Country	:	US
Telephone Number	:	918-794-4788
Fax Number	:	918-794-4789

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

Provider Enumeration Date	:	04/10/2015
Last Update Date	:	01/19/2026

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Directions to “ KAITLIN PAIGE DOMEK ” Practice Location

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