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General NPI Number Information
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NPI Number | 1629861166
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Entity Type | Individual
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Provider Name | DOUGLASH KIPROTICH
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Gender | Male
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 333 W MAIN ST STE 290
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City | ARDMORE
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State | OK
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Zip | 73401-6330
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Country | US
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Telephone | 580-235-1491
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Fax |
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Provider Business Mailing Address
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Address Line | 27 LAKE DR
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City | ARDMORE
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State | OK
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Zip | 73401-8422
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Country | US
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Telephone | 469-728-3580
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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