Basic Information
| Provider Information | |||||||||
| NPI: | 1669700571 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UROLOGIC SPECIALISTS OF OKLAHOMA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10901 E 48TH ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741465830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187498765 | ||||||||
| FaxNumber: | 9183922155 | ||||||||
| Practice Location | |||||||||
| Address1: | 10901 E 48TH ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741465830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187498765 | ||||||||
| FaxNumber: | 9183922155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2009 | ||||||||
| LastUpdateDate: | 04/05/2022 | ||||||||
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| AuthorizedOfficialLastName: | GANCARCZYK | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | JOSEPH | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9187498765 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 04/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246Z00000X | 117717 | OK | N | 193400000X SINGLE SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | 208800000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.