Healthcare Provider Details

I. General information

NPI: 1811527518
Provider Name (Legal Business Name): MIND REJUVENATION, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4922 E 73RD ST
TULSA OK
74136-7007
US

IV. Provider business mailing address

7307 S YALE AVE STE 200
TULSA OK
74136-7049
US

V. Phone/Fax

Practice location:
  • Phone: 918-392-4550
  • Fax: 918-392-4551
Mailing address:
  • Phone: 918-392-4550
  • Fax: 918-392-4551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IFTIKHAR HUSSAIN
Title or Position: MEMBER
Credential: MD
Phone: 918-392-4550