Healthcare Provider Details

I. General information

NPI: 1396954582
Provider Name (Legal Business Name): MITCHELL HOROWITZ MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S BRYANT AVE SUITE 309
EDMOND OK
73034-6399
US

IV. Provider business mailing address

105 S BRYANT AVE SUITE 309
EDMOND OK
73034-6399
US

V. Phone/Fax

Practice location:
  • Phone: 405-471-6464
  • Fax: 405-741-6467
Mailing address:
  • Phone: 405-471-6464
  • Fax: 405-741-6467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number22791
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number22791
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number22791
License Number StateOK

VIII. Authorized Official

Name: DR. MITCHELL HOROWITZ
Title or Position: PRESIDENT
Credential: MD
Phone: 405-471-6464