Provider Demographics
NPI:1174585640
Name:MANGELS, KYLE JOE (MD)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:JOE
Last Name:MANGELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6802 S OLYMPIA AVE
Mailing Address - Street 2:SUITE #275
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-1848
Mailing Address - Country:US
Mailing Address - Phone:918-600-0327
Mailing Address - Fax:918-732-9229
Practice Address - Street 1:6802 S OLYMPIA AVE STE 275
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-1848
Practice Address - Country:US
Practice Address - Phone:918-600-0327
Practice Address - Fax:918-732-9229
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22694174400000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100138240AMedicaid
OK140008042OtherRAILROAD MEDICARE
OK$$$$$$$$$001OtherBCBS
OK$$$$$$$$$001OtherBCBS