Organization
LISA CORSTVET MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CATHY PRICE (MANAGER)
(405) 775-9350
Entity
Organization
Contact information
Practice address
3705 W MEMORIAL RD, 302, OKLAHOMA CITY, OK 73134-1512
(405) 775-9350
(405) 775-9360
Mailing address
3705 W MEMORIAL RD, 302, OKLAHOMA CITY, OK 73134-1512
(405) 775-9350
(405) 775-9360
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
16541
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200110200A
—
OK
01
—
612216600
DOL
OK
01
—
DF8730
MEDICARE RR
OK
Enumeration date
03/02/2007
Last updated
06/05/2008
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