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General NPI Number Information
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NPI Number | 1295000560
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Entity Type | Individual
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Provider Name | KEIVAN ABTAHI D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/19/2012
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Last Update Date | 07/05/2024
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Provider Practice Location Address
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Address Line | 6161 S YALE AVE
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City | TULSA
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State | OK
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Zip | 74136-1992
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Country | US
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Telephone | 918-494-6980
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Fax | 918-494-4573
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Provider Business Mailing Address
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Address Line | 6600 S YALE AVE STE 1400
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City | TULSA
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State | OK
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Zip | 74136-3331
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Country | US
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Telephone | 888-247-0125
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Fax | 918-502-8210
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 5343
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License Number State | OK
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