=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992718381
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AHMED A AMAYEM M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2006
-----------------------------------------------------
Last Update Date | 03/29/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1145 W I 240 SERVICE RD BUILDING # I
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73139-2134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-632-1783
-----------------------------------------------------
Fax | 405-631-0508
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1145 W I 240 SERVICE RD BUILDING I SUITE 100
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73139-2134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-632-1783
-----------------------------------------------------
Fax | 405-631-0508
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208VP0014X
-----------------------------------------------------
Taxonomy Name | Interventional Pain Medicine Physician
-----------------------------------------------------
License Number | 19121
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------