MEDICARE: DR. MARK ROSEKELLY 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	207Q00000X	Family Medicine Physician	6915	OK

General Provider Information

NPI Number	:	1356790133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ROSEKELLY D.O

Provider Business Mailing Address
First Line	:	4086 COUNTRY CLUB RD STE 2
Second Line	:
City	:	DUNCAN
State	:	OK
Zip	:	73533-5580
Country	:	US
Telephone Number	:	580-952-9221
Fax Number	:	616-207-0558

Provider Business Practice Location Address
First Line	:	4086 COUNTRY CLUB RD STE 2
Second Line	:
City	:	DUNCAN
State	:	OK
Zip	:	73533-5580
Country	:	US
Telephone Number	:	580-952-9221
Fax Number	:

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

Provider Enumeration Date	:	06/13/2016
Last Update Date	:	05/07/2024

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