MEDICARE: DR. EMAD SAMIR ATTALLAH-WASIF 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	207LP2900X	Pain Medicine (Anesthesiology) Physician	31431	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	:	1851581185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMAD SAMIR ATTALLAH-WASIF MD

Provider Business Mailing Address
First Line	:	10124 S SHERIDAN RD
Second Line	:	STE B
City	:	TULSA
State	:	OK
Zip	:	74133-6742
Country	:	US
Telephone Number	:	774-473-9119
Fax Number	:	877-220-3112

Provider Business Practice Location Address
First Line	:	10124 S SHERIDAN RD
Second Line	:	STE B
City	:	TULSA
State	:	OK
Zip	:	74133-6742
Country	:	US
Telephone Number	:	774-473-9119
Fax Number	:	877-220-3112

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

Provider Enumeration Date	:	08/01/2007
Last Update Date	:	03/17/2018

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