MEDICARE: LISA MARIE FARHOOD 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	207R00000X	Internal Medicine Physician	19814	OK

General Provider Information

NPI Number	:	1730297631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE FARHOOD M.D.

Provider Business Mailing Address
First Line	:	5401 N PORTLAND
Second Line	:	SUITE 220
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2082
Country	:	US
Telephone Number	:	405-604-4321
Fax Number	:	405-604-4331

Provider Business Practice Location Address
First Line	:	5700 N PORTLAND AVE STE 102
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-1650
Country	:	US
Telephone Number	:	405-458-7654
Fax Number	:	833-973-6081

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	03/24/2026

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