Provider Demographics
NPI:1093222374
Name:MIDTOWN PULMONARY AND CRITICAL CARE SPECIALISTS PLLC
Entity Type:Organization
Organization Name:MIDTOWN PULMONARY AND CRITICAL CARE SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:K
Authorized Official - Last Name:ISHAQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-541-2862
Mailing Address - Street 1:13908 PORTOFINO STRADA
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-5176
Mailing Address - Country:US
Mailing Address - Phone:855-541-2862
Mailing Address - Fax:405-716-4808
Practice Address - Street 1:1104 E STATE HIGHWAY 152 UNIT 1
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-5116
Practice Address - Country:US
Practice Address - Phone:855-541-2862
Practice Address - Fax:405-716-4808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27815207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200331590AMedicaid