Healthcare Provider Details

I. General information

NPI: 1235477613
Provider Name (Legal Business Name): ALEXANDROS MALLIOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2013
Last Update Date: 01/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S WHEELING AVE SUITE 600
TULSA OK
74104-5638
US

IV. Provider business mailing address

450 W 7TH ST
TULSA OK
74119-1051
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-3908
  • Fax:
Mailing address:
  • Phone: 918-510-1735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number29519
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: