Organization
HEBREWSELEVENONE LLC
Active
Organization
HEBREWSELEVENONE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN REDWINE MD (OWNER)
(405) 249-1264
Entity
Organization
Contact information
Practice address
609 W MEMORIAL RD, OKLAHOMA CITY, OK 73114-2006
(405) 418-0059
Mailing address
510 E MEMORIAL RD STE D4, OKLAHOMA CITY, OK 73114-2218
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200066430A
—
OK
Enumeration date
02/06/2018
Last updated
02/06/2018
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