Healthcare Provider Details

I. General information

NPI: 1265582290
Provider Name (Legal Business Name): MARTIN A BAZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/04/2025
Certification Date: 07/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

5841 S MARYLAND AVE # MC1099
CHICAGO IL
60637-1447
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-2429
  • Fax: 405-271-2421
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberV0918
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number036094372
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number43929
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: