Provider Demographics
NPI:1336133024
Name:OPONG-KUSI, MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:OPONG-KUSI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 S UTICA AVE
Mailing Address - Street 2:SUITE 460
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4000
Mailing Address - Country:US
Mailing Address - Phone:918-579-5749
Mailing Address - Fax:918-579-5762
Practice Address - Street 1:1145 S UTICA AVE
Practice Address - Street 2:SUITE 460
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4000
Practice Address - Country:US
Practice Address - Phone:918-579-5749
Practice Address - Fax:918-579-5762
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7833207Q00000X
OK3871207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100016920AMedicaid
OK100016920CMedicaid
OK100016920DMedicaid
OKOK405037Medicare PIN
H79519Medicare UPIN
OK100016920CMedicaid