Provider Demographics
NPI:1245406495
Name:CHRISTOPHER KOLKER, MD PLLC
Entity Type:Organization
Organization Name:CHRISTOPHER KOLKER, MD PLLC
Other - Org Name:CHRISTOPHER KOLKER, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-323-4644
Mailing Address - Street 1:816 FRISCO AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-3701
Mailing Address - Country:US
Mailing Address - Phone:580-323-4644
Mailing Address - Fax:580-323-1620
Practice Address - Street 1:816 FRISCO AVE STE A
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-3701
Practice Address - Country:US
Practice Address - Phone:580-323-4644
Practice Address - Fax:580-323-1620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20223207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200193920AMedicaid
OKOKB5176Medicare PIN
OKOK700197Medicare PIN