MEDICARE: SHANNON KYLE KANEASTER 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	207Y00000X	Otolaryngology Physician	22929	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	:	1275672529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON KYLE KANEASTER M.D.

Provider Business Mailing Address
First Line	:	3033 NW 63RD ST
Second Line	:	SUITE 152
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-3634
Country	:	US
Telephone Number	:	405-755-6651
Fax Number	:	405-607-3559

Provider Business Practice Location Address
First Line	:	5701 N PORTLAND AVE
Second Line	:	SUITE 305
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-1678
Country	:	US
Telephone Number	:	405-604-4475
Fax Number	:	405-604-4480

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	06/01/2016

Similar Medicare Providers

1558387787 — PULMONOLOGY INC
Practice Location Address:

5701 N PORTLAND AVE , SUITE 225
OKLAHOMA CITY, OK
73112-1678

Practice Phone: 405-604-4990
Practice Fax: 405-604-4991

1821012667 — DR. HEATHER H COX D.D.S.
Practice Location Address:

5701 N PORTLAND AVE , STE 121
OKLAHOMA CITY, OK
73112-1678

Practice Phone: 405-604-6400
Practice Fax: 405-604-4229

1699888578 — RHONDA KAYE COTHRAN DPH
Practice Location Address:

5701 N PORTLAND AVE , 123
OKLAHOMA CITY, OK
73112-1678

Practice Phone: 405-949-6410
Practice Fax: 405-949-6412

1619052909 — MEDIC PHARMACY MANAGEMENT INC
Practice Location Address:

5701 N PORTLAND AVE
OKLAHOMA CITY, OK
73112-1678

Practice Phone: 405-949-6410
Practice Fax: 405-949-6412

1083784508 — DR. WILLIAM PAUL TRUELS M.D.
Practice Location Address:

5701 N PORTLAND AVE , SUITE 120
OKLAHOMA CITY, OK
73112-1678

Practice Phone: 405-951-4110
Practice Fax: 405-951-4111

1336261494 — KATHRYN L BREWER MD P C
Practice Location Address:

5701 N PORTLAND AVE , SUITE 325
OKLAHOMA CITY, OK
73112-1678

Practice Phone: 405-951-4980
Practice Fax: 405-951-4981

Directions to “ SHANNON KYLE KANEASTER M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.