Healthcare Provider Details

I. General information

NPI: 1720354202
Provider Name (Legal Business Name): MICHELE L NEIL DO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6048 S SHERIDAN RD
TULSA OK
74145-9212
US

IV. Provider business mailing address

6048 S SHERIDAN RD
TULSA OK
74145-9212
US

V. Phone/Fax

Practice location:
  • Phone: 918-748-3640
  • Fax: 918-748-3644
Mailing address:
  • Phone: 918-748-3640
  • Fax: 918-748-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number4105
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4105
License Number StateTX

VIII. Authorized Official

Name: MICHELE L NEIL
Title or Position: OWNER
Credential: DO
Phone: 918-748-3640