Individual
PRODROMOS MIKE ANGELIDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6161 S YALE AVE, TULSA, OK 74136-1902
(918) 494-5346
(918) 494-6303
Mailing address
6600 S YALE AVE, SUITE 1400, TULSA, OK 74136-3347
(918) 488-6001
(918) 488-6010
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
23934
OK
207R00000X
Internal Medicine Physician
N0610
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
198836201
—
TX
05
—
198836202
—
TX
05
—
198836203
—
TX
Enumeration date
02/07/2007
Last updated
03/15/2012
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