Healthcare Provider Details

I. General information

NPI: 1124138680
Provider Name (Legal Business Name): BASSAM ARODAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 N PORTLAND AVE STE 410
OKLAHOMA CITY OK
73112-2131
US

IV. Provider business mailing address

5300 N INDEPENDENCE AVE STE 280
OKLAHOMA CITY OK
73112-5555
US

V. Phone/Fax

Practice location:
  • Phone: 405-945-4700
  • Fax: 405-945-4270
Mailing address:
  • Phone: 405-945-4700
  • Fax: 405-945-4270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number29261
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: