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Individual

MICHAEL STEPHEN ELLIOTT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
301 E WATERLOO RD, EDMOND, OK 73034-8196
(405) 715-2000
(405) 715-2010
Mailing address
301 E WATERLOO RD, EDMOND, OK 73034-8196
(405) 715-2000
(405) 715-2010

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
19806
OK
208000000X
Pediatrics Physician
19806
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100091460A
OK
01
P00196149
RAILROAD MEDICARE
Enumeration date
07/12/2005
Last updated
02/13/2019
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