Provider Demographics
NPI:1588660898
Name:HIEKE, KENNETH A (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:HIEKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4401 W MEMORIAL RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1785
Mailing Address - Country:US
Mailing Address - Phone:405-752-3162
Mailing Address - Fax:405-936-5211
Practice Address - Street 1:10914 HEFNER POINTE DR
Practice Address - Street 2:STE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5069
Practice Address - Country:US
Practice Address - Phone:405-748-6600
Practice Address - Fax:405-748-6472
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2014-05-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK168282086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE28927Medicare UPIN