Healthcare Provider Details

I. General information

NPI: 1861676736
Provider Name (Legal Business Name): SALAH UDDIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S WHEELING AVE STE 510
TULSA OK
74104-5642
US

IV. Provider business mailing address

4538 S HARVARD AVE
TULSA OK
74135-2906
US

V. Phone/Fax

Practice location:
  • Phone: 918-747-5200
  • Fax: 918-858-0290
Mailing address:
  • Phone: 918-744-2925
  • Fax: 918-744-3671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number63787
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: