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General NPI Number Information
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NPI Number | 1487735593
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Entity Type | Organization
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Legal Business Name | OSTEOPATHIC PHYSICIANS OF TULSA, INC.
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 6465 S YALE AVE STE 401
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City | TULSA
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State | OK
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Zip | 74136-7806
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Country | US
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Telephone | 918-582-3154
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Fax | 918-582-3593
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Provider Business Mailing Address
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Address Line | 6465 S YALE AVE STE 401
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City | TULSA
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State | OK
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Zip | 74136-7823
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Country | US
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Telephone | 918-582-3154
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Fax | 918-582-3593
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | TANA CEDERSTROM
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Credential |
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Telephone | 918-748-3383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 3780
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License Number State | OK
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