Healthcare Provider Details

I. General information

NPI: 1245227123
Provider Name (Legal Business Name): ETHAN WARLICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 E 51ST ST
TULSA OK
74135-3704
US

IV. Provider business mailing address

4710 E 51ST ST
TULSA OK
74135-3704
US

V. Phone/Fax

Practice location:
  • Phone: 918-928-7828
  • Fax:
Mailing address:
  • Phone: 918-928-7828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21053
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: