MEDICARE: OKWAPEDS

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	363LP0200X	Pediatric Nurse Practitioner	12416	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	:	1811227911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKWAPEDS

Provider Business Mailing Address
First Line	:	1211 N SHARTEL AVE STE 606
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-2425
Country	:	US
Telephone Number	:	405-235-9955
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 N SHARTEL AVE STE 606
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-2425
Country	:	US
Telephone Number	:	405-235-9955
Fax Number	:	405-601-4044

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WAZIR S AHMAD
Credential	:	M.D.
Telephone Number	:	405-235-9955

Provider Enumeration Date	:	01/12/2010
Last Update Date	:	01/12/2010

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Directions to “OKWAPEDS ” Practice Location

Language	Start Address	Practice Location

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