Provider Demographics
NPI:1821294406
Name:MANTELL, KRISTIN BROOKE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:BROOKE
Last Name:MANTELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:608 NW 9TH ST STE 6210
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1069
Mailing Address - Country:US
Mailing Address - Phone:405-272-9641
Mailing Address - Fax:405-235-0738
Practice Address - Street 1:1000 N LEE AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102
Practice Address - Country:US
Practice Address - Phone:405-272-9641
Practice Address - Fax:405-235-0738
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK25768207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology