Healthcare Provider Details

I. General information

NPI: 1578183703
Provider Name (Legal Business Name): MITCHELL EZEKIEL MCCAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 E 19TH ST STE 800
TULSA OK
74104-5472
US

IV. Provider business mailing address

1725 E 19TH ST STE 800
TULSA OK
74104-5472
US

V. Phone/Fax

Practice location:
  • Phone: 918-748-7800
  • Fax: 918-403-6349
Mailing address:
  • Phone: 918-748-7800
  • Fax: 918-403-6349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number35991
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: