Healthcare Provider Details

I. General information

NPI: 1629605944
Provider Name (Legal Business Name): SEVERINE KAKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 W MEMORIAL RD STE 102
OKLAHOMA CITY OK
73120-9322
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 405-749-4205
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD227387
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: