Basic Information
| Provider Information | |||||||||
| NPI: | 1831177047 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUESSENHOP | ||||||||
| FirstName: | CHRISTIAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1809 E 13TH ST STE 402 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741044431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185792300 | ||||||||
| FaxNumber: | 9185792309 | ||||||||
| Practice Location | |||||||||
| Address1: | 1809 E 13TH ST STE 402 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185792300 | ||||||||
| FaxNumber: | 9185792309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2006 | ||||||||
| LastUpdateDate: | 08/13/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0114X | 19557 | OK | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 100123170A | 05 | OK | MEDICAID |