Healthcare Provider Details

I. General information

NPI: 1841810850
Provider Name (Legal Business Name): AHMED ABDELSATAR ALI ABOMHYA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2020
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NE 13TH ST STE 1G
OKLAHOMA CITY OK
73104-5040
US

IV. Provider business mailing address

1200 CHILDRENS AVE FL 11
OKLAHOMA CITY OK
73104-4637
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-3445
  • Fax: 405-271-3401
Mailing address:
  • Phone: 405-764-7066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number47313
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: