MEDICARE: DR. MICHAEL HINES TOLLETT 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	207P00000X	Emergency Medicine Physician	28274	CO
2	207P00000X	Emergency Medicine Physician	28274	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	:	1356390397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL HINES TOLLETT D.O.

Provider Business Mailing Address
First Line	:	179133 N 2600 RD
Second Line	:
City	:	WALTERS
State	:	OK
Zip	:	73572-3817
Country	:	US
Telephone Number	:	580-695-4793
Fax Number	:	580-252-1253

Provider Business Practice Location Address
First Line	:	179133 N 2600 RD
Second Line	:
City	:	WALTERS
State	:	OK
Zip	:	73572-3817
Country	:	US
Telephone Number	:	580-695-4793
Fax Number	:	580-252-1253

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	05/22/2024

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Directions to “ DR. MICHAEL HINES TOLLETT D.O.” Practice Location

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