Provider Demographics
NPI:1245382993
Name:ARDIS, JANITA M (MD)
Entity Type:Individual
Prefix:DR
First Name:JANITA
Middle Name:M
Last Name:ARDIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3817 NW EXPRESSWAY ST
Mailing Address - Street 2:SUITE 710
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-1489
Mailing Address - Country:US
Mailing Address - Phone:405-943-8924
Mailing Address - Fax:405-943-8967
Practice Address - Street 1:3817 NW EXPRESSWAY ST
Practice Address - Street 2:SUITE 710
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-1489
Practice Address - Country:US
Practice Address - Phone:405-943-8924
Practice Address - Fax:405-943-8967
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK122502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK94643Medicare UPIN