Provider Demographics
NPI:1790752491
Name:VILLANO, MICHAEL LEE (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:VILLANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3500 HEALTHPLEX PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-9801
Mailing Address - Country:US
Mailing Address - Phone:405-515-2222
Mailing Address - Fax:405-307-5610
Practice Address - Street 1:3500 HEALTHPLEX PKWY STE 200
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-9801
Practice Address - Country:US
Practice Address - Phone:405-515-2222
Practice Address - Fax:405-307-5610
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK24715207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200071870BMedicaid
OK200071870BMedicaid
OKOKA102210Medicare PIN