Healthcare Provider Details

I. General information

NPI: 1487172623
Provider Name (Legal Business Name): TULSA MICRO HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 09/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 WEST 71ST STREET
TULSA OK
74132
US

IV. Provider business mailing address

1415 LOUISIANA ST FL 27
HOUSTON TX
77002-7360
US

V. Phone/Fax

Practice location:
  • Phone: 713-202-3831
  • Fax:
Mailing address:
  • Phone: 713-202-3831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN GRAUBART
Title or Position: PRESIDENT
Credential:
Phone: 713-202-3831