Healthcare Provider Details

I. General information

NPI: 1730162793
Provider Name (Legal Business Name): KIDS HEALTH CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8803 S 101ST EAST AVE 275
TULSA OK
74133-5726
US

IV. Provider business mailing address

8803 S 101ST EAST AVE 275
TULSA OK
74133-5726
US

V. Phone/Fax

Practice location:
  • Phone: 918-252-5437
  • Fax: 918-459-5437
Mailing address:
  • Phone: 918-252-5437
  • Fax: 918-459-5437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROLE BRANDL
Title or Position: OFFICE MANAGER
Credential:
Phone: 918-252-5437