Individual
MICAELA LUPOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
101 N ROBINSON AVE STE 200, OKLAHOMA CITY, OK 73102
(405) 271-8880
(405) 208-8732
Mailing address
1145 S UTICA AVE, STE 460, TULSA, OK 74104-4000
(918) 579-5749
(918) 560-5791
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2497
OK
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100748790A
—
OK
Enumeration date
04/27/2015
Last updated
08/27/2018
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