Unknown Individual – Podiatrist, NPI 1124172143

Unknown Individual is a healthcare provider. based in Tulsa, Oklahoma. specializing in Podiatrist. They hold a License No. 100 (OK). The NPI Number for Unknown Individual is 1124172143

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1124172143
Phone
(918) 492-6333
Address
6966 S UTICA AVE
Deactivation Date
19 August 2021
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 6966, South Utica Avenue, San Souci, Tulsa, Tulsa County, Oklahoma, 74136, United States

    SUITE 225

    TULSA, OK 741363903

    Phone: (918) 492-6333

    Type: Mailing

  • East 31st Street, Fulton, Tulsa, Tulsa County, Oklahoma, 74129, United States

    SUITE 300

    TULSA, OK 741355114

    Phone: (918) 492-6333

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 74136)

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Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1124172143.
What dates should I check for Unknown Individual's activity?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Podiatrist. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Tulsa, Oklahoma in our summary view.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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