Provider Demographics
NPI:1184640112
Name:WINDSOR PARK MEDICAL CLINIC
Entity Type:Organization
Organization Name:WINDSOR PARK MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-605-5415
Mailing Address - Street 1:2512 N MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-1035
Mailing Address - Country:US
Mailing Address - Phone:405-605-5415
Mailing Address - Fax:405-605-5310
Practice Address - Street 1:2512 N MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-1035
Practice Address - Country:US
Practice Address - Phone:405-605-5415
Practice Address - Fax:405-605-5310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty