Healthcare Provider Details

I. General information

NPI: 1639220437
Provider Name (Legal Business Name): TAREK A DERNAIKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13313 N MERIDIAN AVE BUILDING D
OKLAHOMA CITY OK
73120-8380
US

IV. Provider business mailing address

4401 W MEMORIAL RD
OKLAHOMA CITY OK
73134-1785
US

V. Phone/Fax

Practice location:
  • Phone: 405-755-4290
  • Fax: 405-755-7773
Mailing address:
  • Phone: 405-752-3162
  • Fax: 405-936-5211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23760
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number23760
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number23760
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number23760
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: