MEDICARE: KAMRAN MOHAJER MASSOUMI M.D.

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	207W00000X	Ophthalmology Physician	23117	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2386811	OTHER	OK	UNITED HEALTHCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	7072482	OTHER	OK	AETNA

General Provider Information

NPI Number	:	1639172604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMRAN MOHAJER MASSOUMI M.D.

Provider Business Mailing Address
First Line	:	1020 N MAIN ST
Second Line	:
City	:	ELK CITY
State	:	OK
Zip	:	73644-2831
Country	:	US
Telephone Number	:	580-225-1555
Fax Number	:	580-225-1558

Provider Business Practice Location Address
First Line	:	1020 N MAIN ST
Second Line	:
City	:	ELK CITY
State	:	OK
Zip	:	73644-2831
Country	:	US
Telephone Number	:	580-225-1555
Fax Number	:	580-225-1558

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	04/26/2024

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