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General NPI Number Information
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NPI Number | 1659566370
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Entity Type | Organization
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Legal Business Name | TULSA NEUROLOGY & HEADACHE CLINIC, INC
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 1145 S UTICA AVE SUITE 520
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City | TULSA
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State | OK
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Zip | 74104-4000
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Country | US
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Telephone | 918-587-5534
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Fax | 918-587-5610
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Provider Business Mailing Address
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Address Line | PO BOX 21228 DEPT 144
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City | TULSA
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State | OK
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Zip | 74121-1228
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Country | US
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Telephone | 187-774-2631
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Fax | 281-812-2002
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHASHI A HUSAIN
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Credential | M.D
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Telephone | 918-587-5534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 13418
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License Number State | OK
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