Healthcare Provider Details

I. General information

NPI: 1346630779
Provider Name (Legal Business Name): MAJL ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8829 E 77TH ST
TULSA OK
74133-4927
US

IV. Provider business mailing address

8829 E 77TH ST
TULSA OK
74133-4927
US

V. Phone/Fax

Practice location:
  • Phone: 918-991-8168
  • Fax: 918-286-8398
Mailing address:
  • Phone: 918-991-8168
  • Fax: 918-286-8398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number3512263935
License Number StateOK

VIII. Authorized Official

Name: MR. MARK ALLYN LEE
Title or Position: PRESIDENT / CEO
Credential:
Phone: 918-991-8168