Healthcare Provider Details

I. General information

NPI: 1801460779
Provider Name (Legal Business Name): MEHERZAD RAHIMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2021
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 E 41ST ST
TULSA OK
74135-2536
US

IV. Provider business mailing address

101 NE 53RD ST
OKLAHOMA CITY OK
73105-1840
US

V. Phone/Fax

Practice location:
  • Phone: 918-660-3130
  • Fax: 918-660-3132
Mailing address:
  • Phone: 405-630-6661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number39703
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: