MEDICARE: WINDSOR PARK MEDICAL CLINIC, LLC

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

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	37D1027083	OTHER	OK	CLIA #

General Provider Information

NPI Number	:	1699823617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINDSOR PARK MEDICAL CLINIC, LLC

Provider Business Mailing Address
First Line	:	2512 N MERIDIAN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-1035
Country	:	US
Telephone Number	:	405-605-5415
Fax Number	:	405-605-5310

Provider Business Practice Location Address
First Line	:	2512 N MERIDIAN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-1035
Country	:	US
Telephone Number	:	405-605-5415
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KEHDINGA NUKUNA
Credential	:
Telephone Number	:	405-605-5415

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	03/10/2026

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