Organization
PREMISE HEALTH OF OKLAHOMA MEDICAL, P.C
Active
Other names
Premise Health - Broken Arrow
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN LEIZMAN MD (PRESIDENT)
(216) 479-9063
Entity
Organization
Contact information
Practice address
1104 E KENOSHA ST, BROKEN ARROW, OK 74012-2067
(918) 994-6866
(918) 994-6897
Mailing address
5500 MARYLAND WAY STE 400, BRENTWOOD, TN 37027-7048
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
08/15/2018
Last updated
10/13/2022
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