Healthcare Provider Details

I. General information

NPI: 1215228440
Provider Name (Legal Business Name): MICHELLE OLMSTEAD D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 S LEWIS AVE
TULSA OK
74105-5181
US

IV. Provider business mailing address

28667 E 79TH ST S
BROKEN ARROW OK
74014-7092
US

V. Phone/Fax

Practice location:
  • Phone: 918-261-3683
  • Fax:
Mailing address:
  • Phone: 918-261-3683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number5259
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5259
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: