Healthcare Provider Details

I. General information

NPI: 1538777644
Provider Name (Legal Business Name): KOMAL IJAZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 STANTON L YOUNG BLVD # 451
OKLAHOMA CITY OK
73104-5020
US

IV. Provider business mailing address

1122 NE 13TH ST # ORI236
OKLAHOMA CITY OK
73117-1039
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-2422
  • Fax: 405-271-2568
Mailing address:
  • Phone: 405-271-2422
  • Fax: 405-271-2568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10087600
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2020016712
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number48046
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: