MEDICARE: KELLEY M STRUBLE DO

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	207RI0200X	Infectious Disease Physician	4815	OK
2	207RI0200X	Infectious Disease Physician	02004624A	IN

General Provider Information

NPI Number	:	1912167867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY M STRUBLE DO

Provider Business Mailing Address
First Line	:	1923 S UTICA AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74104-6520
Country	:	US
Telephone Number	:	918-403-7054
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 S WHEELING AVE STE 606
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74104-5635
Country	:	US
Telephone Number	:	918-748-7665
Fax Number	:

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

Provider Enumeration Date	:	06/13/2008
Last Update Date	:	04/07/2017

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Directions to “ KELLEY M STRUBLE DO” Practice Location

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