Provider Demographics
NPI:1801068234
Name:GEORGE, MINU MATHEW (MD)
Entity type:Individual
Prefix:DR
First Name:MINU
Middle Name:MATHEW
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 N PHILLIPS AVE
Mailing Address - Street 2:SUITE 4500
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4600
Mailing Address - Country:US
Mailing Address - Phone:405-271-6764
Mailing Address - Fax:405-271-3093
Practice Address - Street 1:1200 N PHILLIPS AVE
Practice Address - Street 2:SUITE 4500
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4600
Practice Address - Country:US
Practice Address - Phone:405-271-6764
Practice Address - Fax:405-271-3093
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246671-1208000000X
OK278662080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200100850AMedicaid