Organization
LISA CORSTVET MD PLLC
Active
Organization
LISA CORSTVET MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERI MOORE (CREDENTIALING COORDINATOR)
(405) 418-4800
Entity
Organization
Contact information
Practice address
4317 W MEMORIAL RD, OKLAHOMA CITY, OK 73134-1720
(405) 418-4800
(405) 418-4820
Mailing address
PO BOX 975008, DALLAS, TX 75397-5008
(405) 418-4800
(405) 418-4820
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
16541
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200257060A
—
OK
01
—
614474300
DOL
OK
Enumeration date
09/03/2009
Last updated
10/21/2020
Update your record
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