Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 1653 | OK |
NPI | 1073601175 |
---|---|
Provider Name | Dr. Kenneth E Calabrese |
First Address | Tulsa, OK 74136-7806 |
Second Address | Tulsa, OK 74136-7806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 12/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100146670A | (05) | OK |
BC0994928 | DEA (01) | OK |
C94577 | (02) |