Provider Demographics
NPI:1073601175
Name:CALABRESE, KENNETH E (DO)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:E
Last Name:CALABRESE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6465 S YALE AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7806
Mailing Address - Country:US
Mailing Address - Phone:918-582-3154
Mailing Address - Fax:
Practice Address - Street 1:6465 S YALE AVE STE 401
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7806
Practice Address - Country:US
Practice Address - Phone:918-582-3154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1653207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100146670AMedicaid
OKBC0994928OtherDEA
OK731103493Medicare ID - Type Unspecified
OKBC0994928OtherDEA