Healthcare Provider Details

I. General information

NPI: 1619888567
Provider Name (Legal Business Name): MEDICAL DIRECTOR SERVICES OKLAHOMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 E BROADWAY ST # OK74403
MUSKOGEE OK
74403-4601
US

IV. Provider business mailing address

4770 WHITE PLAINS RD
BRONX NY
10470-1136
US

V. Phone/Fax

Practice location:
  • Phone: 718-931-9700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL KOHN
Title or Position: MANAGER
Credential:
Phone: 347-631-6775