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General NPI Number Information
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NPI Number | 1619888567
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Entity Type | Organization
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Legal Business Name | MEDICAL DIRECTOR SERVICES OKLAHOMA LLC
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Dates
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Enumeration Date | 09/16/2026
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Last Update Date | 09/16/2026
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Provider Practice Location Address
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Address Line | 1622 E BROADWAY ST # OK74403
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City | MUSKOGEE
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State | OK
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Zip | 74403-4601
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Country | US
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Telephone | 718-931-9700
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Fax |
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Provider Business Mailing Address
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Address Line | 4770 WHITE PLAINS RD
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City | BRONX
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State | NY
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Zip | 10470-1136
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SAMUEL KOHN
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Credential |
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Telephone | 347-631-6775
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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 |
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License Number State |
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