Wonder D Abodakpi
Individual provider Active NPI Case Manager/Care Coordinator · Tulsa, OK
NPI 1699072116 · NPPES record last updated Sep 24, 2014
Key facts
- NPI
- 1699072116
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Case Manager/Care Coordinator 171M00000X
- License
- 303065 (OK)
- Practice address
- 4122 W 55TH Place South
Suite 119
Tulsa, OK 74107-9108 - Phone
- (918) 791-0026
- Fax
- (800) 260-7966
- NPI assigned
- Feb 17, 2011
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 303065 | OK | MD | Case Manager/Care Coordinator |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | 303065 | OK | Yes |
Addresses
Primary practice location
4122 W 55TH Place South
Suite 119
Tulsa, OK 74107-9108
Mailing address
PO Box 702504
Tulsa, OK 74170-2504
Phone (918) 791-0026
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200435470B | Medicaid | OK |
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All providers in Tulsa, OK · Case Manager/Care Coordinator in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 24, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.