Healthcare Provider Details

I. General information

NPI: 1679532170
Provider Name (Legal Business Name): SUZANNE RENEE OLIVE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 E 19TH ST STE 200
TULSA OK
74104-5415
US

IV. Provider business mailing address

1515 N HARVARD AVE STE E
TULSA OK
74115-4957
US

V. Phone/Fax

Practice location:
  • Phone: 918-748-8381
  • Fax: 918-748-8397
Mailing address:
  • Phone: 918-832-6049
  • Fax: 918-832-6055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number16883
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number16883
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number16883
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number16883
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: