Healthcare Provider Details

I. General information

NPI: 1780226860
Provider Name (Legal Business Name): MICHAEL NAKMALI PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 S YALE AVE
TULSA OK
74136-1923
US

IV. Provider business mailing address

6839 S CANTON AVE
TULSA OK
74136-3402
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-0612
  • Fax:
Mailing address:
  • Phone: 918-494-0612
  • 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 Code363A00000X
TaxonomyPhysician Assistant
License Number3162
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: