Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 E 19TH ST
TULSA OK
74104-5403
US

IV. Provider business mailing address

5917 E 26TH PL
TULSA OK
74114-5123
US

V. Phone/Fax

Practice location:
  • Phone: 918-634-7500
  • Fax:
Mailing address:
  • Phone: 720-339-3786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number104163
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: