Healthcare Provider Details

I. General information

NPI: 1871863258
Provider Name (Legal Business Name): OKLAHOMA SENIOR PODIATRY SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3208 BRUSH CREEK RD.
OKLAHOMA CITY OK
73120-1852
US

IV. Provider business mailing address

10 S RIVERSIDE PLZ STE 19 EAST
CHICAGO IL
60606-3728
US

V. Phone/Fax

Practice location:
  • Phone: 866-216-5518
  • Fax: 312-277-6757
Mailing address:
  • Phone: 773-770-0140
  • Fax: 312-277-6757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM K. SMITH SR.
Title or Position: OWNER/PRESIDENT
Credential: D.P.M.
Phone: 866-216-5518