Unknown Individual – Family Medicine Physician, NPI 1861496275
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
North Harvard Avenue, Apache Manor, Tulsa, Tulsa County, Oklahoma, United States
TULSA, OK 741154904
Phone: (918) 832-6051
Fax: (918) 832-6055
Type: Mailing
West Boise Circle, Broken Arrow, Tulsa County, Oklahoma, 74012-9565, United States
BROKEN ARROW, OK 740124932
Phone: (918) 379-6260
Fax: (918) 293-3149
Type: Location
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
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.
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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 74115)
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