MEDICARE: NEENA SUSAN PHILIP MD

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	207R00000X	Internal Medicine Physician	20673	OK

General Provider Information

NPI Number	:	1346244365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEENA SUSAN PHILIP MD

Provider Business Mailing Address
First Line	:	3433 NW 56TH ST
Second Line	:	STE 400
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4430
Country	:	US
Telephone Number	:	405-946-9831
Fax Number	:

Provider Business Practice Location Address
First Line	:	3433 NW 56TH ST
Second Line	:	STE 800
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4455
Country	:	US
Telephone Number	:	405-946-9831
Fax Number	:

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	09/11/2007

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