Individual
DR. MICHAEL WACKOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6161 S YALE AVE, TULSA, OK 74136-1902
(918) 502-1900
(918) 494-6303
Mailing address
6600 S YALE AVE, TULSA, OK 74136-3347
(918) 488-6687
(918) 488-6098
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
18451
OK
208M00000X
Hospitalist Physician
Primary
18451
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100020120A
—
OK
Enumeration date
03/20/2006
Last updated
12/10/2019
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