Provider Demographics
NPI:1255398269
Name:RAMADAN, SUHA TAWFIK (MD)
Entity type:Individual
Prefix:
First Name:SUHA
Middle Name:TAWFIK
Last Name:RAMADAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2836 N KELLY AVE APT 110
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-3154
Mailing Address - Country:US
Mailing Address - Phone:312-515-1356
Mailing Address - Fax:
Practice Address - Street 1:2836 N KELLY AVE APT 110
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-3154
Practice Address - Country:US
Practice Address - Phone:312-515-1356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23369208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH96063Medicare UPIN