Healthcare Provider Details

I. General information

NPI: 1235199209
Provider Name (Legal Business Name): MICHAEL S BRONZE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NE 10TH ST OUPB 4300
OKLAHOMA CITY OK
73104-5417
US

IV. Provider business mailing address

1122 NE 13TH ST ORI 236
OKLAHOMA CITY OK
73117-1039
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-3445
  • Fax:
Mailing address:
  • Phone: 405-271-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number21683
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: