Healthcare Provider Details
I. General information
NPI: 1548825581
Provider Name (Legal Business Name): VITALIS METABOLIC HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/06/2019
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3555 NW 58TH ST STE 910-W
OKLAHOMA CITY OK
73112-4707
US
IV. Provider business mailing address
5030 N MAY AVE # 299
OKLAHOMA CITY OK
73112-6010
US
V. Phone/Fax
- Phone: 405-653-9161
- Fax: 405-653-9163
- Phone: 405-653-9161
- Fax: 405-653-9163
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207R00000X |
| Taxonomy | Internal Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
RYAN
TODD
MORGAN
Title or Position: PRESIDENT
Credential: DO
Phone: 405-653-9161