Provider Demographics
NPI:1588046379
Name:HASENSTEIN, TODD ALAN (DPM)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:ALAN
Last Name:HASENSTEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1919 S WHEELING AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5635
Mailing Address - Country:US
Mailing Address - Phone:918-619-4400
Mailing Address - Fax:918-634-7560
Practice Address - Street 1:1919 S WHEELING AVE STE 600
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5635
Practice Address - Country:US
Practice Address - Phone:918-619-4400
Practice Address - Fax:918-634-7560
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK353213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200918220AMedicaid