Unknown Individual – Family Medicine Physician, NPI 1366527988
Family Medicine Physician
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Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
2028, Mahaney Avenue, Tahlequah, Cherokee County, Oklahoma, 74464, United States
TAHLEQUAH, OK 74464
Phone: (918) 456-0001
Fax: (918) 456-6383
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 74464)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| FAMILY MEDICINE | OK | 83036 | Hemoglobin A1C level | 30 | 24 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | OK | |
| - | OK |
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