MEDICARE: BAHA AL DEEN ABUESHEH MD PC

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	2084N0400X	Neurology Physician	22441	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184631756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAHA AL DEEN ABUESHEH MD PC

Provider Business Mailing Address
First Line	:	PO BOX 268996
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126-8996
Country	:	US
Telephone Number	:	580-223-0447
Fax Number	:	580-223-2989

Provider Business Practice Location Address
First Line	:	1219 A K STREET NW
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-1801
Country	:	US
Telephone Number	:	580-223-0447
Fax Number	:	580-223-2989

Authorized Official
Title or Position	:	OWNER
Name	:	BAHA A ABUESHEH
Credential	:	MD
Telephone Number	:	580-223-0447

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/09/2012

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