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General NPI Number Information
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NPI Number | 1073984621
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Entity Type | Organization
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Legal Business Name | SAWAN SURGICAL AESTHETICS PLLC
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Dates
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Enumeration Date | 10/08/2015
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Last Update Date | 10/08/2015
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Provider Practice Location Address
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Address Line | 209 LILAC DRIVE # 200
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City | EDMOND
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State | OK
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Zip | 73034
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Country | US
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Telephone | 405-788-0785
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 29
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City | NORMAN
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State | OK
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Zip | 73070-0029
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Country | US
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Telephone | 405-788-0785
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Fax |
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Authorized Official
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Title or Position | PLASTIC SURGEON / OWNER
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Name | DR. KAMAL T SAWAN
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Credential | MD
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Telephone | 405-788-0785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 23616
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License Number State | OK
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