Provider Demographics
NPI:1871561001
Name:WACKOWSKI, REBECCA M (MD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:M
Last Name:WACKOWSKI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1919 S WHEELING AVE
Mailing Address - Street 2:404
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5638
Mailing Address - Country:US
Mailing Address - Phone:918-748-7600
Mailing Address - Fax:918-403-6316
Practice Address - Street 1:1919 S WHEELING AVE
Practice Address - Street 2:404
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104
Practice Address - Country:US
Practice Address - Phone:918-748-7600
Practice Address - Fax:918-403-6316
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2018-07-18
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Provider Licenses
StateLicense IDTaxonomies
OK18435207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100148240AMedicaid