Healthcare Provider Details

I. General information

NPI: 1851063135
Provider Name (Legal Business Name): MICAH DANIEL KEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 S HOUSTON AVE STE 304
TULSA OK
74127-9023
US

IV. Provider business mailing address

5310 E 31ST ST STE 13
TULSA OK
74135-5013
US

V. Phone/Fax

Practice location:
  • Phone: 918-382-5064
  • Fax: 918-382-3589
Mailing address:
  • Phone: 918-561-5701
  • Fax: 918-561-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number8673
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: