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General NPI Number Information
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NPI Number | 1457971335
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Entity Type | Organization
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Legal Business Name | UTICA PEDIATRICS
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Dates
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Enumeration Date | 04/21/2020
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Last Update Date | 05/11/2020
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Provider Practice Location Address
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Address Line | 1589 E 19TH ST
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City | TULSA
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State | OK
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Zip | 74120-7629
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Country | US
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Telephone | 918-743-8941
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Fax |
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Provider Business Mailing Address
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Address Line | 1589 E 19TH ST
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City | TULSA
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State | OK
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Zip | 74120-7629
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Country | US
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Telephone | 918-743-8941
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KIM KENDALL
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Credential |
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Telephone | 918-743-8941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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