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General NPI Number Information
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NPI Number | 1295318152
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Entity Type | Individual
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Provider Name | JUSTIN LALTHAWMPUIA SAILO DO
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Gender | Male
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Dates
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Enumeration Date | 04/29/2021
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 7600 S LEWIS AVE
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City | TULSA
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State | OK
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Zip | 74136-6836
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Country | US
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Telephone | 539-399-3410
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Fax | 539-399-3429
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Provider Business Mailing Address
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Address Line | 11511 SHADOW CREEK PKWY
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City | PEARLAND
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State | TX
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Zip | 77584-7298
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Country | US
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Telephone | 713-442-0000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | V6390
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 7760
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License Number State | OK
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