MEDICARE: ANDREW MICHAEL VITALE M.D.

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	208800000X	Urology Physician	40720	OK

General Provider Information

NPI Number	:	1114311271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW MICHAEL VITALE M.D.

Provider Business Mailing Address
First Line	:	4200 W MEMORIAL RD STE 901
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8378
Country	:	US
Telephone Number	:	405-749-4230
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 W MEMORIAL RD STE 901
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8378
Country	:	US
Telephone Number	:	405-749-4230
Fax Number	:

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

Provider Enumeration Date	:	03/26/2015
Last Update Date	:	02/14/2023

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