Individual
MILES BALTHAZOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1715 S BALTIMORE AVE, TULSA, OK 74119-4807
(918) 895-7680
Mailing address
1715 S BALTIMORE AVE, TULSA, OK 74119-4807
(918) 895-7680
Taxonomy
Speciality
Code
Description
License number
State
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11011995
DOB
MO
Enumeration date
08/11/2022
Last updated
05/11/2026
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