Basic Information
| Provider Information | |||||||||
| NPI: | 1376570812 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANDIE | ||||||||
| FirstName: | ANDRONICA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9709 E 79TH ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741334566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9189944000 | ||||||||
| FaxNumber: | 9189944090 | ||||||||
| Practice Location | |||||||||
| Address1: | 9709 EAST 79TH STREET | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741334566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9189944000 | ||||||||
| FaxNumber: | 9182946939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 10/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 231 | AR | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213E00000X | 252 | OK | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213ES0103X | 252 | OK | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.