Provider Demographics
NPI:1770573404
Name:MURIEL, MIGDALIA
Entity type:Individual
Prefix:
First Name:MIGDALIA
Middle Name:
Last Name:MURIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1920
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74465-1920
Mailing Address - Country:US
Mailing Address - Phone:918-284-9251
Mailing Address - Fax:
Practice Address - Street 1:RR 6 BOX 840
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-8703
Practice Address - Country:US
Practice Address - Phone:918-696-8815
Practice Address - Fax:918-696-3879
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK196682080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKH51347Medicare UPIN