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General NPI Number Information
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NPI Number | 1225201718
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Entity Type | Organization
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Legal Business Name | CHRISTIAN CARDIOVASCULAR INSTITUTE PC
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Dates
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Enumeration Date | 04/07/2008
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Last Update Date | 02/19/2018
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Provider Practice Location Address
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Address Line | 3300 NW 56TH STREET SUITE 200
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-4401
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Country | US
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Telephone | 405-947-2228
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Fax | 405-947-2307
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Provider Business Mailing Address
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Address Line | 3300 NW 56TH STREET SUITE 200
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-4401
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Country | US
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Telephone | 405-947-2228
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Fax | 405-947-2307
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DOMINIC M. PEDULLA
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Credential | M.D.
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Telephone | 405-947-2228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 17642
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License Number State | OK
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