Healthcare Provider Details

I. General information

NPI: 1255765376
Provider Name (Legal Business Name): HOUSHANG SERADGE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 SW 44TH ST SUITE 518
OKLAHOMA CITY OK
73109-3613
US

IV. Provider business mailing address

1044 SW 44TH ST SUITE 518
OKLAHOMA CITY OK
73109-3613
US

V. Phone/Fax

Practice location:
  • Phone: 405-634-4263
  • Fax: 405-634-4267
Mailing address:
  • Phone: 405-634-4263
  • Fax: 405-634-4267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number12474
License Number StateOK

VIII. Authorized Official

Name: HOUSHANG SERADGE
Title or Position: PRESIDENT
Credential: MD
Phone: 405-634-4263