MEDICARE: VISAL POK MD

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	24047	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	:	1457487217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VISAL POK MD

Provider Business Mailing Address
First Line	:	2017 W I 35 FRONTAGE RD
Second Line	:	SUITE 190
City	:	EDMOND
State	:	OK
Zip	:	73013-8504
Country	:	US
Telephone Number	:	405-757-3365
Fax Number	:	405-757-3506

Provider Business Practice Location Address
First Line	:	2017 W I 35 FRONTAGE RD
Second Line	:	SUITE 190
City	:	EDMOND
State	:	OK
Zip	:	73013-8504
Country	:	US
Telephone Number	:	405-757-3365
Fax Number	:	405-757-3506

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	09/08/2014

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Directions to “ VISAL POK MD” Practice Location

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