Individual
MIKAELA ROSE KOIVISTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4401 S WESTERN AVE, OKLAHOMA CITY, OK 73109-3413
(405) 834-4573
Mailing address
4401 S WESTERN AVE, OKLAHOMA CITY, OK 73109-3413
(855) 696-2666
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
9185
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/02/2024
Last updated
03/29/2026
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