Healthcare Provider Details

I. General information

NPI: 1851922140
Provider Name (Legal Business Name): JPK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7030 S LEWIS AVE STE M
TULSA OK
74136-3915
US

IV. Provider business mailing address

7030 S LEWIS AVE STE M
TULSA OK
74136-3915
US

V. Phone/Fax

Practice location:
  • Phone: 918-493-1441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN KRUEGER
Title or Position: PHYSICIAN
Credential:
Phone: 918-493-1441