Organization
NORTHSIDE DIGESTIVE DISEASES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM RANDALL KAKISH M.D. (VIC PRESIDENT)
(405) 749-4247
Entity
Organization
Contact information
Practice address
4200 W MEMORIAL RD, 901, OKLAHOMA CITY, OK 73120-9350
(405) 749-4247
(405) 749-4249
Mailing address
4200 W MEMORIAL RD, 901, OKLAHOMA CITY, OK 73120-9350
(405) 749-4247
(405) 749-4249
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Enumeration date
09/12/2007
Last updated
10/31/2007
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