Healthcare Provider Details

I. General information

NPI: 1164617841
Provider Name (Legal Business Name): MAHMOOD A SHAKIR M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 N ROCKWELL AVE
OKLAHOMA CITY OK
73127-3348
US

IV. Provider business mailing address

1435 N ROCKWELL AVE
OKLAHOMA CITY OK
73127-3348
US

V. Phone/Fax

Practice location:
  • Phone: 405-495-3586
  • Fax: 405-495-3597
Mailing address:
  • Phone: 405-495-3586
  • Fax: 405-495-3597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number12648
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number12649
License Number StateOK

VIII. Authorized Official

Name: DR. MAHMOOD A SHAKIR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 405-495-3586