Provider Demographics
NPI:1760405740
Name:KNIFE CHIEF, CHARLES DENNIS (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DENNIS
Last Name:KNIFE CHIEF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:12455 E 100TH ST N
Mailing Address - Street 2:STE 220
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4674
Mailing Address - Country:US
Mailing Address - Phone:918-274-5555
Mailing Address - Fax:918-293-3167
Practice Address - Street 1:12455 E 100TH ST N
Practice Address - Street 2:STE 220
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4674
Practice Address - Country:US
Practice Address - Phone:918-274-5555
Practice Address - Fax:918-293-3167
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2013-05-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK14319207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100213610AMedicaid
OKA51981Medicare UPIN