Healthcare Provider Details

I. General information

NPI: 1811090095
Provider Name (Legal Business Name): KATHYLEE SANTANGELO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 N WESTERN AVE
OKLAHOMA CITY OK
73118-4007
US

IV. Provider business mailing address

5625 N WESTERN AVE
OKLAHOMA CITY OK
73118-4007
US

V. Phone/Fax

Practice location:
  • Phone: 405-739-6596
  • Fax: 405-869-7012
Mailing address:
  • Phone: 405-739-6596
  • Fax: 405-869-7012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number17177
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: