Provider Demographics
NPI:1801819024
Name:CENTER FOR CARDIOVASCULAR MEDICINE
Entity Type:Organization
Organization Name:CENTER FOR CARDIOVASCULAR MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBRATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-744-7887
Mailing Address - Street 1:6966 S UTICA AVE
Mailing Address - Street 2:STE 225
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3903
Mailing Address - Country:US
Mailing Address - Phone:918-492-6333
Mailing Address - Fax:
Practice Address - Street 1:2000 S WHEELING AVE
Practice Address - Street 2:STE 701
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5649
Practice Address - Country:US
Practice Address - Phone:918-744-7887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19731207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty