Organization
NORTHSIDE FAMILY PRACTICE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRAKASH GEORGE (CFO)
(918) 704-9408
Entity
Organization
Contact information
Practice address
3606 N MARTIN LUTHER KING JR BLVD, TULSA, OK 74106-6447
(918) 794-3536
(918) 794-7784
Mailing address
3606 N MARTIN LUTHER KING JR BLVD, TULSA, OK 74106-6447
(918) 794-3536
(918) 794-7784
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
11/18/2011
Last updated
02/24/2025
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