MEDICARE: MS. TAKESHA L MCGEE

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1467732677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAKESHA L MCGEE

Provider Business Mailing Address
First Line	:	1533 NE 42ND ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-6025
Country	:	US
Telephone Number	:	405-243-8050
Fax Number	:	405-522-8130

Provider Business Practice Location Address
First Line	:	1533 NE 42ND ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-6025
Country	:	US
Telephone Number	:	405-243-8050
Fax Number	:	405-522-8130

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

Provider Enumeration Date	:	08/18/2011
Last Update Date	:	08/18/2011

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