Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kenny Susanto, MD

Individual provider Neurology Physician · NPI 1255783270

Kenny Susanto, MD is a Neurology in Tulsa, Oklahoma. Qualified in 2012, 14 years ago. Practices with St John Physicians, Inc, a 264-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Connecticut, Georgia and Oklahoma.

Years since qualifying
14
Licensed in
CT, GA, OK
In the registry since
2016
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

2000 S Wheeling Ave Ste 701
Tulsa, OK 74104-5647
Phone: (918) 748-7810
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Neurology Physician (primary) Taxonomy 2084N0400X · Licence 38794 (OK)
Neurology Physician Taxonomy 2084N0400X · Licence 1.065004 (CT)
Neurology Physician Taxonomy 2084N0400X · Licence 008863 (GA)

Record details

NPI number1255783270
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJuly 2, 2016
Last updated in NPPESJune 27, 2022
Certification dateJuly 30, 2020
Mailing address2000 S Wheeling Ave Ste 701, Tulsa, OK 74104-5647

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNEUROLOGY
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Group practice St. John Physicians, Inc. — 264 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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