Individual
DIMITRI KOULAKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1055 S HOUSTON AVE, TULSA, OK 74127-9043
(918) 921-3299
Mailing address
650 S PEORIA AVE, TULSA, OK 74120-4429
(918) 560-1399
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
009633B
OK
Other
Enumeration date
04/13/2017
Last updated
04/13/2017
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