Individual
THOMAS KELLY TKACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9600 BROADWAY EXT, OKLAHOMA CITY, OK 73114-7408
(405) 230-9000
(405) 230-9477
Mailing address
9600 BROADWAY EXT, OKLAHOMA CITY, OK 73114-7408
(405) 230-9000
(405) 230-9157
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
17380
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100095900A
—
OK
01
—
200022041
RAILROAD MEDICARE
OK
Enumeration date
07/11/2005
Last updated
08/09/2019
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