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NPI Code Detail

MEDICARE: DR. KENNETH A MUCKALA M.D.

MEDICARE: DR. KENNETH A MUCKALA M.D.
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
1207Q00000XFamily Medicine Physician16314OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649233321
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH A MUCKALA M.D.
Provider Business Mailing Address
First Line : 7912 E 31ST CT
Second Line : SUITE 100
City : TULSA
State : OK
Zip : 74145-1315
Country : US
Telephone Number : 918-743-8200
Fax Number : 918-743-8609
Provider Business Practice Location Address
First Line : 7912 E 31ST CT
Second Line : SUITE 100
City : TULSA
State : OK
Zip : 74145-1315
Country : US
Telephone Number : 918-743-8200
Fax Number : 918-743-8200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2006
Last Update Date : 01/11/2010

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