Individual
MR. EUGENE J ICHINOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1265 SOUTH UTICA AVE, SUITE 300, TULSA, OK 74104-4243
(918) 592-0999
(918) 592-1021
Mailing address
9228 S MINGO RD, SUITE 200, TULSA, OK 74133-5718
(918) 592-0999
(918) 592-1021
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
209618
MA
207RC0000X
Cardiovascular Disease Physician
209618
MA
207RC0000X
Cardiovascular Disease Physician
26012
OK
207RI0011X
Interventional Cardiology Physician
209618
MA
207RI0011X
Interventional Cardiology Physician
Primary
26012
OK
207UN0901X
Nuclear Cardiology Physician
209618
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200198060A
—
OK
01
—
P00642514
MEDICARE RAILROAD
OK
Enumeration date
03/08/2006
Last updated
09/16/2016
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