Healthcare Provider Details

I. General information

NPI: 1205836491
Provider Name (Legal Business Name): MEHDI NAVID ADHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 S WALKER AVE BLDG A
OKLAHOMA CITY OK
73139-9475
US

IV. Provider business mailing address

8100 S WALKER AVE BLGD A
OKLAHOMA CITY OK
73139-9402
US

V. Phone/Fax

Practice location:
  • Phone: 405-632-4468
  • Fax: 405-632-0436
Mailing address:
  • Phone: 405-632-4468
  • Fax: 405-631-4964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number13913
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number13913
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number13913
License Number StateOK
# 4
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number13913
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: