Individual
KIM MAKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4802 S 109TH EAST AVE, TULSA, OK 74146-5822
(918) 392-1400
Mailing address
4802 S 109TH EAST AVE, TULSA, OK 74146-5822
(918) 810-9308
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5464
OK
Other
Enumeration date
07/12/2022
Last updated
01/08/2025
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