Provider Demographics
NPI:1093742819
Name:MOHAMMAD, SHIRIN N (MD)
Entity Type:Individual
Prefix:
First Name:SHIRIN
Middle Name:N
Last Name:MOHAMMAD
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 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-636-7650
Mailing Address - Fax:405-636-7743
Practice Address - Street 1:4221 S WESTERN AVE
Practice Address - Street 2:SUITE 3030
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3447
Practice Address - Country:US
Practice Address - Phone:405-636-7650
Practice Address - Fax:405-636-7743
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21819207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100034180BMedicaid
OK100034180BMedicaid
OKG29630Medicare UPIN
OK100034180BMedicaid