Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 121 | OK |
NPI | 1073288049 |
---|---|
Provider Name | Mr. Mark Siegfried Pitambersingh |
First Address | Oklahoma City, OK 73134-1761 |
Second Address | Oklahoma City, OK 73134-1761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2021 |
Last Update Date | 12/08/2021 |