MEDICARE: CRONUS PLLC

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	207R00000X	Internal Medicine Physician	22558	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	:	1326389842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRONUS PLLC

Provider Business Mailing Address
First Line	:	PO BOX 4769
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74159-0769
Country	:	US
Telephone Number	:	918-299-8232
Fax Number	:

Provider Business Practice Location Address
First Line	:	1815 E 15TH ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74104-4610
Country	:	US
Telephone Number	:	918-299-8232
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FARSHID ZANDI
Credential	:	M.D.
Telephone Number	:	918-299-8232

Provider Enumeration Date	:	03/07/2013
Last Update Date	:	03/07/2013

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