Healthcare Provider Details

I. General information

NPI: 1699696880
Provider Name (Legal Business Name): LIVIA KNEIPP RODRIGUES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S SAINT LOUIS AVE
TULSA OK
74120-5440
US

IV. Provider business mailing address

10042 S 94TH EAST AVE
TULSA OK
74133-6139
US

V. Phone/Fax

Practice location:
  • Phone: 918-619-4726
  • Fax:
Mailing address:
  • Phone: 801-362-3430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number50136
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: