Provider Demographics
NPI:1063544237
Name:HAYES, LISA MYKELAN (DO)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MYKELAN
Last Name:HAYES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:MYKELAN
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
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:918-747-4975
Mailing Address - Fax:918-743-8552
Practice Address - Street 1:5801 E 41ST ST STE 900
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5631
Practice Address - Country:US
Practice Address - Phone:918-747-4975
Practice Address - Fax:918-743-8552
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC7-00030182085R0202X
OK45212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200281630AMedicaid
P00849943OtherRAILROAD MEDICARE
P00849943OtherRAILROAD MEDICARE