Healthcare Provider Details

I. General information

NPI: 1366608663
Provider Name (Legal Business Name): TULSA LUNG CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8803 S 101ST EAST AVE SUITE 395
TULSA OK
74133-5726
US

IV. Provider business mailing address

8803 S 101ST EAST AVE SUITE 395
TULSA OK
74133-5726
US

V. Phone/Fax

Practice location:
  • Phone: 256-627-1949
  • Fax:
Mailing address:
  • Phone: 256-627-1949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number26191
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number26191
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number26191
License Number StateOK

VIII. Authorized Official

Name: DR. ALAA A ALRABBAT
Title or Position: SOLE OWNER
Credential: MD
Phone: 256-627-1949