Healthcare Provider Details

I. General information

NPI: 1548821929
Provider Name (Legal Business Name): MICHAELA SANGILLO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 S UTICA AVE
TULSA OK
74104-4243
US

IV. Provider business mailing address

1265 S UTICA AVE
TULSA OK
74104-4243
US

V. Phone/Fax

Practice location:
  • Phone: 918-592-0999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number9067
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: