MEDICARE: WYNTER WILLIAMS KIPGEN 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	18443	OK

General Provider Information

NPI Number	:	1366434300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WYNTER WILLIAMS KIPGEN M.D.

Provider Business Mailing Address
First Line	:	1202 W FARM RD
Second Line	:
City	:	STILLWATER
State	:	OK
Zip	:	74078-4226
Country	:	US
Telephone Number	:	405-744-7665
Fax Number	:	405-744-2059

Provider Business Practice Location Address
First Line	:	1202 W FARM RD
Second Line	:
City	:	STILLWATER
State	:	OK
Zip	:	74078-4226
Country	:	US
Telephone Number	:	405-744-7665
Fax Number	:	405-744-2059

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	02/06/2024

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