Provider Demographics
NPI:1053639203
Name:JANICE L. CHLEBORAD M.D.,PLLC
Entity Type:Organization
Organization Name:JANICE L. CHLEBORAD M.D.,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:REDDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-256-0900
Mailing Address - Street 1:1017 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-3009
Mailing Address - Country:US
Mailing Address - Phone:580-256-0900
Mailing Address - Fax:580-256-0905
Practice Address - Street 1:1017 17TH ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-3009
Practice Address - Country:US
Practice Address - Phone:580-256-0900
Practice Address - Fax:580-256-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16446174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty