MEDICARE: MOHAMAD A. MAHAYNI, M.D., INC.

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	207RC0000X	Cardiovascular Disease Physician	19349	OK

General Provider Information

NPI Number	:	1841441151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOHAMAD A. MAHAYNI, M.D., INC.

Provider Business Mailing Address
First Line	:	3502 W OKMULGEE ST
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74401-5073
Country	:	US
Telephone Number	:	918-682-2700
Fax Number	:	918-682-2733

Provider Business Practice Location Address
First Line	:	3502 W OKMULGEE ST
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74401-5073
Country	:	US
Telephone Number	:	918-682-2700
Fax Number	:	918-682-2733

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MOHAMAD A. MAHAYNI
Credential	:	M.D.
Telephone Number	:	918-682-2700

Provider Enumeration Date	:	10/06/2008
Last Update Date	:	11/08/2010

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