Healthcare Provider Details

I. General information

NPI: 1821268707
Provider Name (Legal Business Name): KYLE BIELEFELD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 E 36TH ST N
TULSA OK
74106-1812
US

IV. Provider business mailing address

PO BOX 268838
OKLAHOMA CITY OK
73126-8838
US

V. Phone/Fax

Practice location:
  • Phone: 918-619-4400
  • Fax: 918-634-7878
Mailing address:
  • Phone: 918-619-4400
  • Fax: 918-634-7878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number29875
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: