Healthcare Provider Details

I. General information

NPI: 1245324433
Provider Name (Legal Business Name): RADWAN KESSERWAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RADWAN A.H. KESSERWAN M.D.

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 N.W. 9TH STREET SUITE 6105
OKLAHOMA CITY OK
73102-1006
US

IV. Provider business mailing address

608 N.W. 9TH STREET SUITE 6105
OKLAHOMA CITY OK
73102-1006
US

V. Phone/Fax

Practice location:
  • Phone: 405-231-3841
  • Fax: 405-231-3705
Mailing address:
  • Phone: 405-231-3841
  • Fax: 405-231-3705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number22414
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number22414
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207RI0001X
TaxonomyClinical & Laboratory Immunology (Internal Medicine) Physician
License Number22414
License Number StateOK
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number22414
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: