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1053763334
CHARLES BLAGOVICH
TULSA, OK
NPI
1053763334
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: OK 121198)
Enumeration Date
2016-07-11
Last Update Date
2016-07-11
Business Address
-- CHARLES BLAGOVICH
6600 S YALE AVE
TULSA, OK 74136-3347
Phone number: 740-505-7569
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Mailing Address
-- CHARLES BLAGOVICH
6600 S YALE AVE
TULSA, OK 74136-3347
Phone number: 740-505-7569
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