Provider Demographics
NPI:1003092578
Name:H. T. KURKJIAN MD INC
Entity Type:Organization
Organization Name:H. T. KURKJIAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:H
Authorized Official - Middle Name:T
Authorized Official - Last Name:KURKJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-755-2780
Mailing Address - Street 1:4200 W MEMORIAL RD
Mailing Address - Street 2:SUITE 713
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-9350
Mailing Address - Country:US
Mailing Address - Phone:405-755-2780
Mailing Address - Fax:405-608-0234
Practice Address - Street 1:4200 W MEMORIAL RD
Practice Address - Street 2:SUITE 713
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9350
Practice Address - Country:US
Practice Address - Phone:405-755-2780
Practice Address - Fax:405-608-0234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10422208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1110422Medicaid
OK=========003OtherBCBS OF OKLAHOMA
OK1110422Medicaid