MEDICARE: MITCHELL W DUININCK 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	207Q00000X	Family Medicine Physician	15889	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023088440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL W DUININCK MD

Provider Business Mailing Address
First Line	:	7501 RIVERSIDE PKWY
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-5056
Country	:	US
Telephone Number	:	918-710-4200
Fax Number	:	918-403-6331

Provider Business Practice Location Address
First Line	:	7501 RIVERSIDE PKWY
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136
Country	:	US
Telephone Number	:	918-710-4200
Fax Number	:	918-403-6331

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	07/11/2018

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