Healthcare Provider Details

I. General information

NPI: 1457768376
Provider Name (Legal Business Name): KEREN BARTAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

G. RAINEY WILLIAMS PAVILION 1290
OKLAHOMA CITY OK
73126
US

IV. Provider business mailing address

G. RAINEY WILLIAMS PAVILION 1290
OKLAHOMA CITY OK
73126
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5504
  • Fax:
Mailing address:
  • Phone: 405-271-5504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number30519
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number30519
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: