Healthcare Provider Details

I. General information

NPI: 1285298414
Provider Name (Legal Business Name): ELLA KUCHMIY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 04/25/2025
Certification Date: 04/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 S UTICA AVE
TULSA OK
74104-6520
US

IV. Provider business mailing address

4715 E 91ST ST STE 100
TULSA OK
74137-2847
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-3131
  • Fax:
Mailing address:
  • Phone: 918-744-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP61390638
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7068
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: