Healthcare Provider Details

I. General information

NPI: 1386036960
Provider Name (Legal Business Name): MICHAEL JAWORSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 SW 115TH ST
OKLAHOMA CITY OK
73170-2630
US

IV. Provider business mailing address

2700 SW 115TH ST
OKLAHOMA CITY OK
73170-2630
US

V. Phone/Fax

Practice location:
  • Phone: 940-867-4505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number303382
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number79559
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: