Provider Demographics
NPI:1932826385
Name:KARDOKUS, KOLTON MATTHEW (DO)
Entity type:Individual
Prefix:
First Name:KOLTON
Middle Name:MATTHEW
Last Name:KARDOKUS
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 1:1015 E 36TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-3003
Mailing Address - Country:US
Mailing Address - Phone:405-545-2120
Mailing Address - Fax:
Practice Address - Street 1:OSU COLLEGE OF OSTEOPATHIC MEDICINE
Practice Address - Street 2:1111 W 17TH ST.
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74107
Practice Address - Country:US
Practice Address - Phone:405-545-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK0816R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program