Individual
MARK STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1245 S UTICA AVE STE 301, TULSA, OK 74104-4214
(918) 382-2536
(918) 382-2576
Mailing address
1245 S UTICA AVE STE 301, TULSA, OK 74104-4214
(918) 382-2536
(918) 382-2576
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
34812
OK
390200000X
Student in an Organized Health Care Education/Training Program
34812
OK
Other
Enumeration date
03/27/2019
Last updated
06/24/2022
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