Healthcare Provider Details

I. General information

NPI: 1619711512
Provider Name (Legal Business Name): TULSA CARDIOLOGY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 S UTICA AVE STE 202
TULSA OK
74114-1437
US

IV. Provider business mailing address

2100 S UTICA AVE STE 202
TULSA OK
74114-1437
US

V. Phone/Fax

Practice location:
  • Phone: 918-932-3836
  • Fax: 918-203-0027
Mailing address:
  • Phone: 918-932-3836
  • Fax: 918-203-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAWAD TRAD
Title or Position: OWNER
Credential: DO
Phone: 405-880-5600