MEDICARE: DR. STEVEN M FISHKIN PH.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
1	103TC0700X	Clinical Psychologist	405	OK

General Provider Information

NPI Number	:	1760665392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN M FISHKIN PH.D.

Provider Business Mailing Address
First Line	:	2228 NW 119TH TER
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-7817
Country	:	US
Telephone Number	:	405-751-6474
Fax Number	:

Provider Business Practice Location Address
First Line	:	2228 NW 119TH TER
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-7817
Country	:	US
Telephone Number	:	405-751-6474
Fax Number	:

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

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	12/05/2007

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