Basic Information
| Provider Information | |||||||||
| NPI: | 1306056205 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WYNTER KIPGEN MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 20358 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731560358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056056141 | ||||||||
| FaxNumber: | 4056056244 | ||||||||
| Practice Location | |||||||||
| Address1: | 3555 NW 58TH ST | ||||||||
| Address2: | SUITE 901 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731124707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056084520 | ||||||||
| FaxNumber: | 4056084523 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 03/02/2016 | ||||||||
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| AuthorizedOfficialLastName: | KIPGEN | ||||||||
| AuthorizedOfficialFirstName: | WYNTER | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 4057157131 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 18443 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.