Healthcare Provider Details

I. General information

NPI: 1659614105
Provider Name (Legal Business Name): DEEPA PHILIP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 S UTICA AVE FL 4
TULSA OK
74104-6520
US

IV. Provider business mailing address

1923 S UTICA AVE FL 4
TULSA OK
74104-6520
US

V. Phone/Fax

Practice location:
  • Phone: 918-748-7650
  • Fax: 918-403-6348
Mailing address:
  • Phone: 918-748-7650
  • Fax: 918-403-6348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number29894
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: