MEDICARE: BRANDON KITCHENS DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	59.000978	OH
2	213ES0103X	Foot & Ankle Surgery Podiatrist	399	OK

General Provider Information

NPI Number	:	1538797428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON KITCHENS DPM

Provider Business Mailing Address
First Line	:	4812 S 109TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74146-5826
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4812 S 109TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74146-5826
Country	:	US
Telephone Number	:	918-236-4500
Fax Number	:

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

Provider Enumeration Date	:	03/28/2020
Last Update Date	:	04/17/2024

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Directions to “ BRANDON KITCHENS DPM” Practice Location

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