Provider Demographics
NPI:1720973001
Name:MILES, JUSTIN K (MPA)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:K
Last Name:MILES
Suffix:
Gender:M
Credentials:MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3613 E 55TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3811
Mailing Address - Country:US
Mailing Address - Phone:918-706-6067
Mailing Address - Fax:
Practice Address - Street 1:6333 E SKELLY DR STE 602
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6101
Practice Address - Country:US
Practice Address - Phone:918-706-6067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist