Healthcare Provider Details

I. General information

NPI: 1295359248
Provider Name (Legal Business Name): OPTIMUM COMPLETE CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 E. INTERSTATE 240 SERVICE RD.
OKLAHOMA CITY OK
73135
US

IV. Provider business mailing address

7725 W RENO AVE STE 150
OKLAHOMA CITY OK
73127-9712
US

V. Phone/Fax

Practice location:
  • Phone: 405-416-9701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MUHAMMAD SANAULLAH
Title or Position: OWNER
Credential: MD
Phone: 405-888-9949