Healthcare Provider Details

I. General information

NPI: 1124083845
Provider Name (Legal Business Name): ADEEL QAISAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 STANTON L YOUNG BLVD
OKLAHOMA CITY OK
73104-5036
US

IV. Provider business mailing address

9105 LA STRADA CT
DALLAS TX
75220-7809
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4351
  • Fax: 405-271-8695
Mailing address:
  • Phone: 573-489-0108
  • Fax: 972-715-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberN0387
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2003002800
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberN0387
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberN0387
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number33644
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: