Healthcare Provider Details

I. General information

NPI: 1801152335
Provider Name (Legal Business Name): OWASSO FAMILY MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13720 E 86TH ST N STE 100
OWASSO OK
74055-8704
US

IV. Provider business mailing address

7011 GREENBRIER DR
OWASSO OK
74055-5992
US

V. Phone/Fax

Practice location:
  • Phone: 918-212-6332
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL PISARIK
Title or Position: OWNER
Credential: M.D.
Phone: 918-212-6332