Provider Demographics
NPI:1073192647
Name:WORSHAM-FRYE, MIKAEL ANN (DO)
Entity Type:Individual
Prefix:
First Name:MIKAEL
Middle Name:ANN
Last Name:WORSHAM-FRYE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MIKAELANN
Other - Middle Name:
Other - Last Name:WORSHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:4502 E 41ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4502 E 41ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2536
Practice Address - Country:US
Practice Address - Phone:918-619-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program