Provider Demographics
NPI:1093794406
Name:OMSTEAD, KALA J (DO)
Entity Type:Individual
Prefix:
First Name:KALA
Middle Name:J
Last Name:OMSTEAD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9001 S 101ST EAST AVE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5711
Mailing Address - Country:US
Mailing Address - Phone:918-392-7000
Mailing Address - Fax:918-392-7013
Practice Address - Street 1:9001 S 101ST EAST AVE
Practice Address - Street 2:STE 270
Practice Address - City:TULLSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5711
Practice Address - Country:US
Practice Address - Phone:918-392-7000
Practice Address - Fax:918-392-7013
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3526207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100097460CMedicaid
OK800522535OtherMEDICARE GROUP PIN
OK247714501Medicare PIN
OK800522535OtherMEDICARE GROUP PIN