Healthcare Provider Details

I. General information

NPI: 1306469648
Provider Name (Legal Business Name): MICHAEL KOLE MELTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S UTICA AVE
TULSA OK
74104-4012
US

IV. Provider business mailing address

1120 S UTICA AVE
TULSA OK
74104-4012
US

V. Phone/Fax

Practice location:
  • Phone: 918-579-8200
  • Fax: 918-579-8204
Mailing address:
  • Phone: 918-579-8200
  • Fax: 918-579-8204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number35858
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number1306469648
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: