MEDICARE: JEANIE L. KLABZUBA D.O.

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	207Q00000X	Family Medicine Physician	4229	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	33605	OTHER	OK	OBNDD
3	4229	OTHER	OK	LICENSE

General Provider Information

NPI Number	:	1699719773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANIE L. KLABZUBA D.O.

Provider Business Mailing Address
First Line	:	5201 W MEMORIAL ROAD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73142-2004
Country	:	US
Telephone Number	:	405-755-4050
Fax Number	:	405-749-9566

Provider Business Practice Location Address
First Line	:	5201 W MEMORIAL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73142-2016
Country	:	US
Telephone Number	:	405-755-4050
Fax Number	:	405-752-1553

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	06/06/2017

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