MEDICARE: HOUSHANG SERADGE MD

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	207XS0106X	Orthopaedic Hand Surgery Physician	12474	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	990009843	OTHER	OK	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1306841903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOUSHANG SERADGE MD

Provider Business Mailing Address
First Line	:	PO BOX 26706
Second Line	:	SECTION 4135
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126-0706
Country	:	US
Telephone Number	:	405-634-4263
Fax Number	:	405-634-4287

Provider Business Practice Location Address
First Line	:	1044 SW 44TH ST
Second Line	:	SUITE 518
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3613
Country	:	US
Telephone Number	:	405-634-4263
Fax Number	:	405-634-4267

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/14/2014

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Directions to “ HOUSHANG SERADGE MD” Practice Location

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