Healthcare Provider Details

I. General information

NPI: 1093775413
Provider Name (Legal Business Name): KAYSE M SHRUM D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 S HOUSTON AVE FL 4
TULSA OK
74127-9023
US

IV. Provider business mailing address

717 S HOUSTON AVE FL 4
TULSA OK
74127-9023
US

V. Phone/Fax

Practice location:
  • Phone: 918-382-4600
  • Fax: 918-382-3183
Mailing address:
  • Phone: 918-382-4600
  • Fax: 918-382-3183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3697
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: