MEDICARE: DR. ALIREZA ABOLMAALI DAMGHANI 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	207Q00000X	Family Medicine Physician	26582	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	OK401155	OTHER	OK	MEDICARE PTAN

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	:	1427275775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALIREZA ABOLMAALI DAMGHANI MD

Provider Business Mailing Address
First Line	:	1001 S DOUGLAS BLVD
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-5251
Country	:	US
Telephone Number	:	214-392-7042
Fax Number	:	405-739-0335

Provider Business Practice Location Address
First Line	:	1001 S DOUGLAS BLVD
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-5251
Country	:	US
Telephone Number	:	214-392-7042
Fax Number	:	405-739-0335

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	10/08/2010

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