MEDICARE: UNIVERSITY OF OKLAHOMA

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	282NW0100X	Women's Hospital	27022	OK

General Provider Information

NPI Number	:	1770814121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF OKLAHOMA

Provider Business Mailing Address
First Line	:	450 W 7TH ST APT 301
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74119-1046
Country	:	US
Telephone Number	:	310-869-3212
Fax Number	:

Provider Business Practice Location Address
First Line	:	4502 E 41ST ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-9923
Country	:	US
Telephone Number	:	918-660-8359
Fax Number	:

Authorized Official
Title or Position	:	RESIDENT PHYSICIAN
Name	:	SOORENA FATEHCHEHR
Credential	:	M.D.
Telephone Number	:	310-869-3212

Provider Enumeration Date	:	01/25/2010
Last Update Date	:	01/25/2010

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