Provider Demographics
NPI:1902293103
Name:KAMMERZELL, SAMUEL (DO)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:KAMMERZELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1919 S WHEELING AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5631
Mailing Address - Country:US
Mailing Address - Phone:918-748-7600
Mailing Address - Fax:918-403-6316
Practice Address - Street 1:1919 S WHEELING AVE STE 200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5631
Practice Address - Country:US
Practice Address - Phone:918-748-7600
Practice Address - Fax:918-403-6316
Is Sole Proprietor?:No
Enumeration Date:2015-04-25
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK6431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine