Healthcare Provider Details

I. General information

NPI: 1114267523
Provider Name (Legal Business Name): CARDIOVASCULAR SURGERY OF TULSA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 N MIDWEST BLVD SUITE 201
MIDWEST CITY OK
73110-4311
US

IV. Provider business mailing address

238 N MIDWEST BLVD SUITE 201
MIDWEST CITY OK
73110-4311
US

V. Phone/Fax

Practice location:
  • Phone: 405-869-7013
  • Fax: 405-737-0912
Mailing address:
  • Phone: 405-869-7013
  • Fax: 405-737-0912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number21550
License Number StateOK

VIII. Authorized Official

Name: ABBAS TOUGHANIPOUR
Title or Position: PRESIDENT
Credential: MD
Phone: 405-869-7013