Healthcare Provider Details

I. General information

NPI: 1487735593
Provider Name (Legal Business Name): OSTEOPATHIC PHYSICIANS OF TULSA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 S YALE AVE STE 401
TULSA OK
74136-7806
US

IV. Provider business mailing address

6465 S YALE AVE STE 401
TULSA OK
74136-7823
US

V. Phone/Fax

Practice location:
  • Phone: 918-582-3154
  • Fax: 918-582-3593
Mailing address:
  • Phone: 918-582-3154
  • Fax: 918-582-3593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number3780
License Number StateOK

VIII. Authorized Official

Name: TANA CEDERSTROM
Title or Position: PRACTICE MANAGER
Credential:
Phone: 918-748-3383