MEDICARE: DR. MICHAEL SCOTT CONNOLLY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	43138	OK
2	2084P0800X	Psychiatry Physician	6150978-1205	UT

General Provider Information

NPI Number	:	1003014374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL SCOTT CONNOLLY MD

Provider Business Mailing Address
First Line	:	700 NE 13TH ST # 38
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5004
Country	:	US
Telephone Number	:	405-764-8066
Fax Number	:	405-271-1001

Provider Business Practice Location Address
First Line	:	920 STANTON L YOUNG BLVD STE 3240
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5036
Country	:	US
Telephone Number	:	405-271-5251
Fax Number	:	405-271-5759

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2007
Last Update Date	:	03/13/2026

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