MEDICARE: INTERNATIONAL UNIVERSITY

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	208D00000X	General Practice Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1184095457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNATIONAL UNIVERSITY

Provider Business Mailing Address
First Line	:	2706 S 109TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74129-7634
Country	:	US
Telephone Number	:	918-299-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2706 S 109TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74129-7634
Country	:	US
Telephone Number	:	918-299-1100
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CRAIG LAMB
Credential	:	MD
Telephone Number	:	918-671-5000

Provider Enumeration Date	:	10/13/2015
Last Update Date	:	10/13/2015

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Directions to “INTERNATIONAL UNIVERSITY ” Practice Location

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