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General NPI Number Information
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NPI Number | 1720354202
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Entity Type | Organization
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Legal Business Name | MICHELE L NEIL DO, PLLC
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Dates
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Enumeration Date | 03/28/2012
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 6048 S SHERIDAN RD
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City | TULSA
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State | OK
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Zip | 74145-9212
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Country | US
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Telephone | 918-748-3640
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Fax | 918-748-3644
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Provider Business Mailing Address
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Address Line | 6048 S SHERIDAN RD
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City | TULSA
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State | OK
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Zip | 74145-9212
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Country | US
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Telephone | 918-748-3640
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Fax | 918-748-3644
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Authorized Official
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Title or Position | OWNER
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Name | MICHELE L NEIL
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Credential | DO
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Telephone | 918-748-3640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number | 4105
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4105
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License Number State | TX
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