Provider Demographics
NPI:1932528015
Name:OKLAHOMA LIFE ACCESS, PLLC
Entity Type:Organization
Organization Name:OKLAHOMA LIFE ACCESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAWLESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-744-2442
Mailing Address - Street 1:1819 E 19TH ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5407
Mailing Address - Country:US
Mailing Address - Phone:918-744-2442
Mailing Address - Fax:918-403-0166
Practice Address - Street 1:7519 S 49TH WEST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74131-3402
Practice Address - Country:US
Practice Address - Phone:918-477-3790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200534300AMedicaid