Southern Oklahoma Lifestyles and Preventative Medicine

NPI #1538673256 in Ardmore, Oklahoma

Provider Information

NPI Number: 1538673256
Entity Type: Organization
Organization Name: Southern Oklahoma Lifestyles and Preventative Medicine
Subpart: Yes (part of a larger organization)
Parent Organization: PARADIGM HORMONES, PLLC
Primary Specialty: Preventive Medicine - Public Health & General Preventive Medicine
Enumeration Date: Nov 17, 2017
Last Updated: Nov 17, 2017

Practice Location

Address: 731 12TH AVE NW STE 201
City: Ardmore
State: Oklahoma
ZIP Code: 73401-5764
Phone: (405) 703-3614

Authorized Official

Name: NIKKI BUSELLATO
Title: INS. CREDENTIALING
Phone: (405) 703-3614

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Preventive Medicine - Public Health & General Preventive Medicine — Public Health & General Preventive Medicine	2083P0901X	Primary

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