Individual
KYLE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
921 NE 13TH ST, PROSTHETICS DEPARTMENT, OKLAHOMA CITY, OK 73104-5007
(405) 456-5656
(405) 456-1532
Mailing address
921 NE 13TH ST, PROSTHETICS DEPARTMENT, OKLAHOMA CITY, OK 73104-5007
(405) 456-5656
(405) 456-1532
Taxonomy
Speciality
Code
Description
License number
State
224L00000X
Pedorthist
Primary
—
—
Other
Enumeration date
03/09/2017
Last updated
03/09/2017
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