MEDICARE: OKLAHOMA SENIOR PODIATRY SERVICES, P.C.

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	213E00000X	Podiatrist

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

General Provider Information

NPI Number	:	1871863258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKLAHOMA SENIOR PODIATRY SERVICES, P.C.

Provider Business Mailing Address
First Line	:	10 S RIVERSIDE PLZ
Second Line	:	STE 19 EAST
City	:	CHICAGO
State	:	IL
Zip	:	60606-3728
Country	:	US
Telephone Number	:	773-770-0140
Fax Number	:	312-277-6757

Provider Business Practice Location Address
First Line	:	3208 BRUSH CREEK RD.
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-1852
Country	:	US
Telephone Number	:	866-216-5518
Fax Number	:	312-277-6757

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	WILLIAM K. SMITH SR.
Credential	:	D.P.M.
Telephone Number	:	866-216-5518

Provider Enumeration Date	:	01/03/2012
Last Update Date	:	09/11/2012

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