MEDICARE: CHANDLER CLINIC A DIVISION OF PLAZA MEDICAL GROUP, PC

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	2298	OK

General Provider Information

NPI Number	:	1427240118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANDLER CLINIC A DIVISION OF PLAZA MEDICAL GROUP, PC

Provider Business Mailing Address
First Line	:	3433 NW 56TH ST STE 400
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4430
Country	:	US
Telephone Number	:	405-948-4040
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 N HIGHWAY 18
Second Line	:
City	:	CHANDLER
State	:	OK
Zip	:	74834-1200
Country	:	US
Telephone Number	:	405-258-2500
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PAUL SYZMANSKI
Credential	:
Telephone Number	:	405-948-4040

Provider Enumeration Date	:	08/16/2007
Last Update Date	:	08/16/2007

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