Healthcare Provider Details

I. General information

NPI: 1013602945
Provider Name (Legal Business Name): TECUMSEH HAWK DUSHANE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 S HARVARD AVE
TULSA OK
74114-3300
US

IV. Provider business mailing address

212 NORTHSIDE CT
TAHLEQUAH OK
74464-6204
US

V. Phone/Fax

Practice location:
  • Phone: 918-712-4301
  • Fax:
Mailing address:
  • Phone: 918-718-4432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: