Healthcare Provider Details

I. General information

NPI: 1043272982
Provider Name (Legal Business Name): MICHAEL P CARNEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 09/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 S JACKSON AVE SUITE 500
TULSA OK
74127-9015
US

IV. Provider business mailing address

802 S JACKSON AVE SUITE 500
TULSA OK
74127-9015
US

V. Phone/Fax

Practice location:
  • Phone: 918-582-7711
  • Fax:
Mailing address:
  • Phone: 918-582-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number1811
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: