Healthcare Provider Details

I. General information

NPI: 1851025373
Provider Name (Legal Business Name): OKLAHOMA PODIATRIC MEDICINE & SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13401 N WESTERN AVE STE 405
OKLAHOMA CITY OK
73114-1412
US

IV. Provider business mailing address

13401 N WESTERN AVE STE 405
OKLAHOMA CITY OK
73114-1412
US

V. Phone/Fax

Practice location:
  • Phone: 405-607-3667
  • Fax:
Mailing address:
  • Phone: 405-607-3667
  • Fax: 405-607-3670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: LEILA STRAEHLA
Title or Position: OWNER
Credential: DPM
Phone: 785-554-2951