MEDICARE: MICHAEL L. ENGELBRECHT, 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	1223G0001X	General Practice Dentistry	5222	OK

General Provider Information

NPI Number	:	1447472824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL L. ENGELBRECHT, PC

Provider Business Mailing Address
First Line	:	6565 SOUTH YALE AVENUE
Second Line	:	SUITE 1104
City	:	TULSA
State	:	OK
Zip	:	74136
Country	:	US
Telephone Number	:	918-492-9420
Fax Number	:	918-492-4768

Provider Business Practice Location Address
First Line	:	6565 SOUTH YALE AVENUE
Second Line	:	SUITE 1104
City	:	TULSA
State	:	OK
Zip	:	74136
Country	:	US
Telephone Number	:	918-492-9420
Fax Number	:	918-492-4768

Authorized Official
Title or Position	:	OFFICE ADMINSTRATOR
Name	:	MRS. JOANNE ELAINE BENSON
Credential	:
Telephone Number	:	918-492-9420

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	08/22/2020

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