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KENNY SUSANTO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2000 S WHEELING AVE STE 701, TULSA, OK 74104-5647
(918) 748-7810
Mailing address
2000 S WHEELING AVE STE 701, TULSA, OK 74104-5647

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
008863
GA
2084N0400X
Neurology Physician
1.065004
CT
2084N0400X
Neurology Physician
Primary
38794
OK

Other

Enumeration date
07/02/2016
Last updated
06/27/2022
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