Individual
LISA MARGARET CORSTVET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4317 W MEMORIAL RD, OKLAHOMA CITY, OK 73134-1720
(405) 418-4800
(405) 418-4820
Mailing address
PO BOX 975008, DALLAS, TX 75397-5008
(405) 418-4800
(405) 418-4820
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
16541
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100107550A
—
OK
01
—
612216600
DOL
OK
01
—
P00398663
MEDICARE RR
OK
Enumeration date
07/27/2006
Last updated
07/31/2020
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