Provider Demographics
NPI:1124061551
Name:COHLMIA, GEORGE SHAKER JR (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:SHAKER
Last Name:COHLMIA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2448 E 81ST ST
Mailing Address - Street 2:SUITE 5100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4248
Mailing Address - Country:US
Mailing Address - Phone:918-584-2500
Mailing Address - Fax:918-584-4634
Practice Address - Street 1:1373 E BOONE ST
Practice Address - Street 2:SUITE 3400
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-3364
Practice Address - Country:US
Practice Address - Phone:918-456-9500
Practice Address - Fax:918-456-9569
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK15023174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100197620AMedicaid
OKD34516Medicare UPIN