Healthcare Provider Details

I. General information

NPI: 1770624694
Provider Name (Legal Business Name): ELIAS SOLOMON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 S WESTERN AVE SUITE 2010
OKLAHOMA CITY OK
73109-3413
US

IV. Provider business mailing address

9020 E RENO AVE
MIDWEST CITY OK
73130-3336
US

V. Phone/Fax

Practice location:
  • Phone: 405-231-0540
  • Fax: 405-644-5309
Mailing address:
  • Phone: 405-732-7020
  • Fax: 405-732-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number24555
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number24555
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: