Healthcare Provider Details

I. General information

NPI: 1497486468
Provider Name (Legal Business Name): MADISON WINTERSCHEIDT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 S UTICA AVE STE 300
TULSA OK
74104-4214
US

IV. Provider business mailing address

1245 S UTICA AVE STE 300
TULSA OK
74104-4214
US

V. Phone/Fax

Practice location:
  • Phone: 918-592-0999
  • Fax: 918-592-1262
Mailing address:
  • Phone: 918-592-0999
  • Fax: 918-592-1262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: