Healthcare Provider Details

I. General information

NPI: 1487356028
Provider Name (Legal Business Name): DAVIS OLIYIL KURIAKOSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 S WESTERN AVE
OKLAHOMA CITY OK
73109-3413
US

IV. Provider business mailing address

2020 59TH ST W
BRADENTON FL
34209-4604
US

V. Phone/Fax

Practice location:
  • Phone: 405-636-7000
  • Fax:
Mailing address:
  • Phone: 941-792-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9637
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: