Provider Demographics
NPI:1427099035
Name:MAROUK, JOHN S (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:MAROUK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 S ATLANTA PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1771
Mailing Address - Country:US
Mailing Address - Phone:918-583-5131
Mailing Address - Fax:918-592-0670
Practice Address - Street 1:2128 S ATLANTA PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1771
Practice Address - Country:US
Practice Address - Phone:918-583-5131
Practice Address - Fax:918-592-0670
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3038207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10096350AMedicaid
OK175215700OtherDEPARTMENT OF LABOR
OK0005436495OtherAETNA
OK10096350AMedicaid
OK0005436495OtherAETNA
OK140006120Medicare PIN
OKG49055Medicare UPIN