Provider Demographics
NPI:1164140679
Name:SESTAK RHEUMATOLOGY
Entity Type:Organization
Organization Name:SESTAK RHEUMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SESTAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-615-2421
Mailing Address - Street 1:3555 NW 58TH ST STE 804
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4703
Mailing Address - Country:US
Mailing Address - Phone:405-615-2421
Mailing Address - Fax:650-727-5319
Practice Address - Street 1:3555 NW 58TH ST STE 804
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4703
Practice Address - Country:US
Practice Address - Phone:405-548-0430
Practice Address - Fax:405-463-4408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric RheumatologyGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty