Healthcare Provider Details

I. General information

NPI: 1487976320
Provider Name (Legal Business Name): ANN E BARTOLONI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 E 15TH ST
TULSA OK
74104-4611
US

IV. Provider business mailing address

1844 E 15TH ST
TULSA OK
74104-4611
US

V. Phone/Fax

Practice location:
  • Phone: 918-749-7177
  • Fax: 918-749-7309
Mailing address:
  • Phone: 918-749-7177
  • Fax: 918-749-7309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number15205
License Number StateOK

VIII. Authorized Official

Name: ANN BARTOLONI
Title or Position: PHYSICIAN
Credential:
Phone: 918-749-7177