MEDICARE: DR. KRISTI G SELF 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	208100000X	Physical Medicine & Rehabilitation Physician	18173	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	250013313	OTHER	OK	RAILROAD MEDICARE

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	:	1528030970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTI G SELF MD

Provider Business Mailing Address
First Line	:	5100 N BROOKLINE AVE STE 500
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-3626
Country	:	US
Telephone Number	:	405-605-8780
Fax Number	:	405-605-8782

Provider Business Practice Location Address
First Line	:	5100 N BROOKLINE AVE
Second Line	:	SUITE 500
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-3623
Country	:	US
Telephone Number	:	405-605-8780
Fax Number	:	405-605-8782

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

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	01/12/2016

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Directions to “ DR. KRISTI G SELF MD” Practice Location

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