Healthcare Provider Details

I. General information

NPI: 1952659732
Provider Name (Legal Business Name): OKLAHOMA SLEEP SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4157 S HARVARD AVE STE 130
TULSA OK
74135-2631
US

IV. Provider business mailing address

6966 S UTICA AVE STE 225
TULSA OK
74136-3903
US

V. Phone/Fax

Practice location:
  • Phone: 918-492-6333
  • Fax: 918-493-9405
Mailing address:
  • Phone: 918-492-6333
  • Fax: 918-493-9405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number22222
License Number StateOK

VIII. Authorized Official

Name: MICHAEL B NEWNAM
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 918-743-8200