Healthcare Provider Details

I. General information

NPI: 1750951398
Provider Name (Legal Business Name): ANNA LILLIE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2021
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 S YALE AVE STE 815
TULSA OK
74136-7820
US

IV. Provider business mailing address

6600 S YALE AVE STE 1200
TULSA OK
74136-3361
US

V. Phone/Fax

Practice location:
  • Phone: 918-502-4848
  • Fax: 918-502-4850
Mailing address:
  • Phone: 918-499-4855
  • Fax: 918-488-6098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number8138
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: