Organization
PROVIDENCE SURGICAL GROUP AT BAILEY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL D MANN M.D. (OWNER)
(918) 298-2138
Entity
Organization
Contact information
Practice address
10512 N 110TH EAST AVE, SUITE 200, OWASSO, OK 74055
(918) 344-6266
(918) 298-2138
Mailing address
117 E 122ND PL, JENKS, OK 74037-2860
(918) 298-2138
(918) 298-2138
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
24688
OK
Other
Enumeration date
01/10/2007
Last updated
08/22/2020
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