MEDICARE: LISA JUNELLA VILES

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	2085U0001X	Diagnostic Ultrasound Physician	145036	OK

General Provider Information

NPI Number	:	1083566004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA JUNELLA VILES

Provider Business Mailing Address
First Line	:	8310 S ELWOOD AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74132-3221
Country	:	US
Telephone Number	:	918-671-0760
Fax Number	:

Provider Business Practice Location Address
First Line	:	8310 S ELWOOD AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74132-3221
Country	:	US
Telephone Number	:	918-671-0760
Fax Number	:

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

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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Directions to “ LISA JUNELLA VILES ” Practice Location

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