Provider Demographics
NPI:1073288049
Name:PITAMBERSINGH, MARK SIEGFRIED (CPO, LPO)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:SIEGFRIED
Last Name:PITAMBERSINGH
Suffix:
Gender:M
Credentials:CPO, LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4207 W MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1761
Mailing Address - Country:US
Mailing Address - Phone:405-525-4000
Mailing Address - Fax:
Practice Address - Street 1:4207 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1761
Practice Address - Country:US
Practice Address - Phone:405-525-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK121224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist