Provider Demographics
NPI:1902809080
Name:REVELIS, ANDREAS FRANK (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREAS
Middle Name:FRANK
Last Name:REVELIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10810 E 45TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-3806
Mailing Address - Country:US
Mailing Address - Phone:918-742-7030
Mailing Address - Fax:918-742-9958
Practice Address - Street 1:10810 E 45TH ST STE 400
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-3806
Practice Address - Country:US
Practice Address - Phone:918-742-7030
Practice Address - Fax:918-742-9958
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21829207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100097430AMedicaid
OK100097430AMedicaid
OK244305603Medicare PIN