Organization
TULSA VEIN INSTITUTE PLLC
Active
Organization
TULSA VEIN INSTITUTE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN DAVIN HARAWAY D.O. (PRACTITIONER)
(918) 706-2161
Entity
Organization
Contact information
Practice address
6901 S YORKTOWN AVE, TULSA, OK 74136-3986
(918) 706-2161
(918) 701-2021
Mailing address
6901 S YORKTOWN AVE, TULSA, OK 74136-3986
(918) 706-2161
(918) 701-2021
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
3263
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200582270A
—
OK
01
—
405679
MEDICARE PTAN
OK
Enumeration date
03/09/2015
Last updated
10/06/2022
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