Provider Demographics
NPI:1083682140
Name:LAKIN, TERRENCE LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:LEE
Last Name:LAKIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:
Other - Last Name:LAKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4713 N PORTWEST CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67204-2356
Mailing Address - Country:US
Mailing Address - Phone:443-851-3130
Mailing Address - Fax:443-214-0636
Practice Address - Street 1:7134 S YALE AVE STE 430
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6351
Practice Address - Country:US
Practice Address - Phone:918-600-2243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6295208D00000X
CO33749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68454571Medicaid
COCOAAA1237OtherMEDICARE PTAN