Organization
GRAND LAKE IMAGING PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN JAMES YUNT D.O. (PRESIDENT)
(918) 221-7506
Entity
Organization
Contact information
Practice address
1001 E 18TH ST, GROVE, OK 74344-2907
(918) 221-7506
Mailing address
PO BOX 2264, INDIANAPOLIS, IN 46206-2264
(918) 221-7506
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100748880A
—
OK
01
—
DN4636
RAILROAD MEDICARE
—
Enumeration date
03/24/2006
Last updated
03/30/2023
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