Healthcare Provider Details

I. General information

NPI: 1710087283
Provider Name (Legal Business Name): MICHAEL BIRKENHOLZ R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 N. LINCOLN BLVD
OKLAHOMA CITY OK
73105
US

IV. Provider business mailing address

2801 PLYMOUTH LANE
OKLAHOMA CITY OK
73120
US

V. Phone/Fax

Practice location:
  • Phone: 405-425-0341
  • Fax: 405-425-0313
Mailing address:
  • Phone: 405-748-3882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR 0080437
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: