Healthcare Provider Details

I. General information

NPI: 1770705915
Provider Name (Legal Business Name): FIDELIS RADIOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7718 E 91ST ST SUITE 220
TULSA OK
74133-6045
US

IV. Provider business mailing address

P.O. BOX 702586
TULSA OK
74170
US

V. Phone/Fax

Practice location:
  • Phone: 918-392-0720
  • Fax:
Mailing address:
  • Phone: 918-392-0720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRETT H KOLMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 918-392-0720