Provider Demographics
NPI:1912923012
Name:KLOS, KEVIN J (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:KLOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7134 S YALE AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-6378
Mailing Address - Country:US
Mailing Address - Phone:918-392-4530
Mailing Address - Fax:918-392-4535
Practice Address - Street 1:7134 S YALE AVE
Practice Address - Street 2:STE 205
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6378
Practice Address - Country:US
Practice Address - Phone:918-392-4530
Practice Address - Fax:918-392-4535
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2017-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK24389207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200086020AMedicaid
OK200086020AMedicaid
OK244624306Medicare PIN