Organization
LIFESTYLE MEDICINE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RENAE MAYER MD (OWNER)
(918) 488-9874
Entity
Organization
Contact information
Practice address
2405 E SKELLY DR, TULSA, OK 74105-6006
(918) 488-9874
(918) 587-3437
Mailing address
2405 E SKELLY DR, TULSA, OK 74105-6006
(918) 488-9874
(918) 587-3437
Taxonomy
Speciality
Code
Description
License number
State
207RH0000X
Hematology (Internal Medicine) Physician
Primary
22105
OK
Other
Enumeration date
06/09/2015
Last updated
06/09/2015
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