Provider Demographics
NPI:1366757387
Name:CHAMBERLAIN, MICHAEL CHAD (DO)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CHAD
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:244 S. GATEWAY PL.
Mailing Address - Street 2:SUITE 401
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037
Mailing Address - Country:US
Mailing Address - Phone:918-747-2020
Mailing Address - Fax:918-747-2056
Practice Address - Street 1:244 S. GATEWAY PL.
Practice Address - Street 2:SUITE 401
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037
Practice Address - Country:US
Practice Address - Phone:918-747-2020
Practice Address - Fax:918-747-2056
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2019-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK4974207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK289477YR94Medicare PIN
OKOKA103035Medicare PIN
OK289477ZJBTMedicare PIN