MEDICARE: KEITH JOHN KASSABIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0011X	Interventional Cardiology Physician	16576	OK
2	207RC0000X	Cardiovascular Disease Physician	16576	OK

General Provider Information

NPI Number	:	1083618003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH JOHN KASSABIAN

Provider Business Mailing Address
First Line	:	608 NW 9TH ST
Second Line	:	SUITE 2200
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73102-1068
Country	:	US
Telephone Number	:	405-231-3737
Fax Number	:	405-272-6144

Provider Business Practice Location Address
First Line	:	608 NW 9TH ST
Second Line	:	SUITE 2200
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73102-1068
Country	:	US
Telephone Number	:	405-231-3737
Fax Number	:	405-272-6144

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	10/20/2020

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Directions to “ KEITH JOHN KASSABIAN ” Practice Location

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