Provider Demographics
NPI:1942380878
Name:DOMINIC LOSACCO MD INC
Entity Type:Organization
Organization Name:DOMINIC LOSACCO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:
Authorized Official - Last Name:LOSACCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-491-5767
Mailing Address - Street 1:6565 S YALE
Mailing Address - Street 2:SUITE 706
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8308
Mailing Address - Country:US
Mailing Address - Phone:918-491-5767
Mailing Address - Fax:918-491-5771
Practice Address - Street 1:6565 S YALE
Practice Address - Street 2:SUITE 706
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8308
Practice Address - Country:US
Practice Address - Phone:918-491-5767
Practice Address - Fax:918-491-5771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C95189Medicare UPIN