MEDICARE: TAZEEN MAUDUDI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	24712	OK

General Provider Information

NPI Number	:	1811100571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAZEEN MAUDUDI MD

Provider Business Mailing Address
First Line	:	7919 MID AMERICA BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-6610
Country	:	US
Telephone Number	:	405-432-0738
Fax Number	:

Provider Business Practice Location Address
First Line	:	7919 MID AMERICA BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-6610
Country	:	US
Telephone Number	:	405-855-6005
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	05/02/2018

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