Provider Demographics
NPI:1669545992
Name:CHRYSANT, STEVEN G (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:G
Last Name:CHRYSANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 W WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-4904
Mailing Address - Country:US
Mailing Address - Phone:405-721-6662
Mailing Address - Fax:405-721-8417
Practice Address - Street 1:5850 W WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-4904
Practice Address - Country:US
Practice Address - Phone:405-721-6662
Practice Address - Fax:405-721-8417
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9883174400000X, 282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC94773Medicare UPIN