Individual
DR. THERESE M.B. AMIGO
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
401 S YORK ST, CCOM MEDICAL GROUP, INC., MUSKOGEE, OK 74403-5955
(918) 683-1144
(918) 683-5316
Mailing address
350 S 40TH ST, CCOM MEDICAL GROUP, INC., MUSKOGEE, OK 74401-4915
(918) 683-0753
(918) 687-5251
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
21291
OK
Other
Enumeration date
03/09/2006
Last updated
07/08/2007
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