Healthcare Provider Details

I. General information

NPI: 1073288049
Provider Name (Legal Business Name): MARK SIEGFRIED PITAMBERSINGH CPO, LPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4207 W MEMORIAL RD
OKLAHOMA CITY OK
73134-1761
US

IV. Provider business mailing address

4207 W MEMORIAL RD
OKLAHOMA CITY OK
73134-1761
US

V. Phone/Fax

Practice location:
  • Phone: 405-525-4000
  • Fax:
Mailing address:
  • Phone: 405-525-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number121
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: