Individual
MR. MICHAEL JEROME ITEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
6160 S YALE AVE, TULSA, OK 74136-1930
(918) 495-2600
(918) 497-3007
Mailing address
6600 S YALE AVE STE 1400, TULSA, OK 74136-3331
(888) 247-0125
(918) 502-8210
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2274
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200499900A
—
OK
Enumeration date
05/01/2006
Last updated
05/03/2024
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