Provider Demographics
NPI:1538472923
Name:LENKER, MICHAEL DEREK (MED)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DEREK
Last Name:LENKER
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 W DAWS ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-7017
Mailing Address - Country:US
Mailing Address - Phone:405-329-3674
Mailing Address - Fax:
Practice Address - Street 1:122 E EUFAULA ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6017
Practice Address - Country:US
Practice Address - Phone:405-447-4499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator