MEDICARE: DR. SIAVASH NAEL M.D.

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	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician	12064	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	731186241	OTHER	OK	TAX ID UNDER GROUP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902809353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIAVASH NAEL M.D.

Provider Business Mailing Address
First Line	:	4720 S WESTERN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3834
Country	:	US
Telephone Number	:	405-634-5529
Fax Number	:	405-636-1673

Provider Business Practice Location Address
First Line	:	4720 S WESTERN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109
Country	:	US
Telephone Number	:	405-634-5529
Fax Number	:	405-636-1673

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	09/13/2018

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