Provider Demographics
NPI:1255765376
Name:HOUSHANG SERADGE MD PC
Entity type:Organization
Organization Name:HOUSHANG SERADGE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOUSHANG
Authorized Official - Middle Name:
Authorized Official - Last Name:SERADGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-634-4263
Mailing Address - Street 1:1044 SW 44TH ST
Mailing Address - Street 2:SUITE 518
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3613
Mailing Address - Country:US
Mailing Address - Phone:405-634-4263
Mailing Address - Fax:405-634-4267
Practice Address - Street 1:1044 SW 44TH ST
Practice Address - Street 2:SUITE 518
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3613
Practice Address - Country:US
Practice Address - Phone:405-634-4263
Practice Address - Fax:405-634-4267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK124742086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty