Basic Information
| Provider Information | |||||||||
| NPI: | 1154398352 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATHEW | ||||||||
| FirstName: | MIGY | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 921NE 13 ST. | ||||||||
| Address2: | VA MEDICAL CENTER-111 AC | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054561000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 921 NE 13TH ST | ||||||||
| Address2: | VA MEDICAL CENTER-111-AC | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731045007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052713050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 03/06/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 21183 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207QG0300X | 21183 | OK | N | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
No ID Information.