MEDICARE: KAYSE M SHRUM D.O.

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	208000000X	Pediatrics Physician	3697	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OK404764	OTHER	OK	MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1093775413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYSE M SHRUM D.O.

Provider Business Mailing Address
First Line	:	717 S HOUSTON AVE FL 4
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74127-9023
Country	:	US
Telephone Number	:	918-382-4600
Fax Number	:	918-382-3183

Provider Business Practice Location Address
First Line	:	717 S HOUSTON AVE FL 4
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74127-9023
Country	:	US
Telephone Number	:	918-382-4600
Fax Number	:	918-382-3183

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	02/12/2019

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Directions to “ KAYSE M SHRUM D.O.” Practice Location

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