Healthcare Provider Details

I. General information

NPI: 1285636829
Provider Name (Legal Business Name): RUNAKO D WHITTAKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1334 N LANSING AVE
TULSA OK
74106-5907
US

IV. Provider business mailing address

1334 N LANSING AVE 1334 N. LANSING AVE.
TULSA OK
74106-5907
US

V. Phone/Fax

Practice location:
  • Phone: 918-587-2171
  • Fax: 918-295-6155
Mailing address:
  • Phone: 918-587-2171
  • Fax: 918-295-6155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21966
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: