Provider Demographics
NPI:1699758961
Name:JANZEN, MARK A (MD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:JANZEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4930
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74159-0930
Mailing Address - Country:US
Mailing Address - Phone:918-934-8347
Mailing Address - Fax:918-743-8552
Practice Address - Street 1:5801 E. 41ST STREET
Practice Address - Street 2:SUITE 900
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5631
Practice Address - Country:US
Practice Address - Phone:918-934-8347
Practice Address - Fax:918-743-8552
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK183162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100224530AMedicaid
OK300033051OtherRAILROAD MEDICARE
OK243407701OtherMEDICARE
OK300129659OtherRAILROAD MEDICARE
OK300033051OtherRAILROAD MEDICARE
OKTULSR125Medicare ID - Type Unspecified