Provider Demographics
NPI:1679929707
Name:TKACH, CHRISTOPHER KELLY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:KELLY
Last Name:TKACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 STANTON L YOUNG BLVD
Mailing Address - Street 2:WP-1380
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5036
Mailing Address - Country:US
Mailing Address - Phone:405-271-5964
Mailing Address - Fax:405-271-4917
Practice Address - Street 1:711 STANTON L YOUNG BLVD
Practice Address - Street 2:PPB-111
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5023
Practice Address - Country:US
Practice Address - Phone:405-271-4906
Practice Address - Fax:405-271-4910
Is Sole Proprietor?:No
Enumeration Date:2016-05-07
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK32408207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery