Healthcare Provider Details

I. General information

NPI: 1275282923
Provider Name (Legal Business Name): LIZA SALLOUM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 S YALE AVE
TULSA OK
74136-1992
US

IV. Provider business mailing address

6161 S YALE AVE
TULSA OK
74136-1992
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-2200
  • Fax:
Mailing address:
  • Phone: 918-494-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9447
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: