MEDICARE: OKLAHOMA PODIATRIC MEDICINE & SURGERY PLLC

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	213ES0103X	Foot & Ankle Surgery Podiatrist
2	213EP1101X	Primary Podiatric Medicine Podiatrist

General Provider Information

NPI Number	:	1851025373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKLAHOMA PODIATRIC MEDICINE & SURGERY PLLC

Provider Business Mailing Address
First Line	:	13401 N WESTERN AVE STE 405
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-1412
Country	:	US
Telephone Number	:	405-607-3667
Fax Number	:	405-607-3670

Provider Business Practice Location Address
First Line	:	13401 N WESTERN AVE STE 405
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-1412
Country	:	US
Telephone Number	:	405-607-3667
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LEILA STRAEHLA
Credential	:	DPM
Telephone Number	:	785-554-2951

Provider Enumeration Date	:	07/11/2022
Last Update Date	:	11/28/2022

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