Healthcare Provider Details

I. General information

NPI: 1366429201
Provider Name (Legal Business Name): ANDREW S KHOUW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 S YALE AVE
TULSA OK
74136-1930
US

IV. Provider business mailing address

6600 S YALE AVE STE 1400
TULSA OK
74136-3310
US

V. Phone/Fax

Practice location:
  • Phone: 918-497-3140
  • Fax:
Mailing address:
  • Phone: 918-488-6001
  • Fax: 918-488-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number17844
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: