Individual
DR. KIMBALL N PRATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
620 24TH AVE SW, NORMAN, OK 73069
(405) 325-5800
Mailing address
1122 NE 13TH ST, ORI 236, OKLAHOMA CITY, OK 73117-1039
(405) 325-5800
(405) 701-5927
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
26028
OK
207T00000X
Neurological Surgery Physician
4301065100
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1406100832
BLUE CROSS
MI
05
—
200194340A
—
OK
05
—
3147543-10
—
MI
Enumeration date
06/15/2006
Last updated
05/23/2013
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