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Last Update: Thursday, December 19, 2024 3:44 AM CST
Next Update: Thursday, December 19, 2024 12:00 PM CST
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SISWANTO, LISA HANDAYANI
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This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.
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| Practice Address: |
8803 S 101ST E AVE SUITE 200
TULSA OK 74133
Address last updated on 5/14/2024 |
| Phone #: |
(918) 307-2273 |
| Fax #: |
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| County: |
TULSA |
| License: |
28493 |
| Dated: |
7/1/2012 |
| Expires: |
7/1/2025 |
| License Type: |
Medical Doctor |
| Specialty: |
Pediatrics |
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| Status: |
Active |
| Status Class: |
Fully Licensed |
| Restricted to: |
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| Registered to Dispense: |
NO |
| Medical School: |
Univ Of Ok Coll Of Med, Oklahoma City Ok 73190 |
| Graduated: |
5 /
2011 |
| CME Year: |
2027 |
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Pending and/or Past Disciplinary Actions:
No Disciplinary Action Taken.
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All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
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| Certifications: |
AMERICAN BOARD OF PEDIATRICS |
| New Patients: |
Contact licensee |
| Medicaid: |
Contact licensee |
| Medicare: |
Contact licensee |
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| HMO/PPO: |
None listed |
| Hospital Privileges: |
Hillcrest Hospital South (fmly SouthCrest)
Tulsa, OK
St. Francis Hospital
Tulsa, OK
St. Francis Hospital - SOUTH
Tulsa, OK
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