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General NPI Number Information
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NPI Number | 1902498686
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Entity Type | Organization
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Legal Business Name | KYLE J MANGELS MD, PLC
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Dates
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Enumeration Date | 02/04/2021
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 6802 S OLYMPIA AVE STE 275
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City | TULSA
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State | OK
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Zip | 74132-1848
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Country | US
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Telephone | 918-600-0327
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Fax | 918-732-9229
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Provider Business Mailing Address
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Address Line | 6802 S OLYMPIA AVE STE 275
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City | TULSA
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State | OK
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Zip | 74132-1848
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Country | US
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Telephone | 918-600-0327
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Fax | 918-732-9229
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | BRITTNEY PAYNE
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Credential |
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Telephone | 918-600-0327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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