Healthcare Provider Details

I. General information

NPI: 1770111353
Provider Name (Legal Business Name): MADELINE L. O'SULLIVAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2488 E 81ST ST STE 290
TULSA OK
74137-4299
US

IV. Provider business mailing address

2488 E 81ST ST STE 290
TULSA OK
74137-4299
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-2665
  • Fax: 918-927-3193
Mailing address:
  • Phone: 918-494-2665
  • Fax: 918-927-3193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number48229
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: