Healthcare Provider Details

I. General information

NPI: 1104854256
Provider Name (Legal Business Name): STEVEN D CHERNAUSEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N PHILLIPS AVE SUITE 4500
OKLAHOMA CITY OK
73104-4600
US

IV. Provider business mailing address

1200 N PHILLIPS AVE SUITE 4500
OKLAHOMA CITY OK
73104-4600
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-2767
  • Fax: 405-271-3093
Mailing address:
  • Phone: 405-271-2767
  • Fax: 405-271-3093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number25584
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: