MEDICARE: DR. KENNETH DANIEL OSTMO DO

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	207R00000X	Internal Medicine Physician	7023	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578026647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH DANIEL OSTMO DO

Provider Business Mailing Address
First Line	:	6600 S YALE AVE STE 1400
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-3331
Country	:	US
Telephone Number	:	888-247-0125
Fax Number	:	918-502-8210

Provider Business Practice Location Address
First Line	:	6465 S YALE AVE STE 704
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-7822
Country	:	US
Telephone Number	:	918-502-4250
Fax Number	:	918-502-4255

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

Provider Enumeration Date	:	04/07/2019
Last Update Date	:	05/19/2026

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