Individual
DR. BLAKE JUSTIN LESSELROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MBI
Contact information
Practice address
4502 E 41ST ST, TULSA, OK 74135-2536
(918) 660-3596
Mailing address
1414 E 39TH ST APT 2-349, TULSA, OK 74105-3343
(971) 303-3627
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
34337
OK
207R00000X
Internal Medicine Physician
MD24554
OR
Other
Enumeration date
09/26/2006
Last updated
12/14/2018
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