Provider Demographics
NPI:1023000338
Name:MCCORMACK, STEVEN T (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:T
Last Name:MCCORMACK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6757 S YALE AVE
Mailing Address - Street 2:SUITE 276W
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3302
Mailing Address - Country:US
Mailing Address - Phone:918-523-0002
Mailing Address - Fax:918-523-0030
Practice Address - Street 1:17310 WRIGHT ST STE 103
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2405
Practice Address - Country:US
Practice Address - Phone:833-228-6889
Practice Address - Fax:877-853-0376
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2024-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WY11403C2085R0202X
GUMTL-2023-0292085R0202X
ND152602085R0202X
MO20180245212085R0202X
GUM-24212085R0202X
OK178462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK245520601Medicare PIN
OKE66087Medicare UPIN