Healthcare Provider Details

I. General information

NPI: 1265871800
Provider Name (Legal Business Name): OKLAHOMA WOUND CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10912 E 14TH ST
TULSA OK
74128-4845
US

IV. Provider business mailing address

976 MCLEAN AVE
YONKERS NY
10704-4105
US

V. Phone/Fax

Practice location:
  • Phone: 918-438-2440
  • Fax: 918-439-9594
Mailing address:
  • Phone: 914-237-6797
  • Fax: 914-237-6790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number228653
License Number StateNY

VIII. Authorized Official

Name: SPERO THEODOROU
Title or Position: SURGICAL DIRECTOR
Credential: M.D.
Phone: 914-237-6797