Provider Demographics
NPI:1114267523
Name:CARDIOVASCULAR SURGERY OF TULSA PC
Entity Type:Organization
Organization Name:CARDIOVASCULAR SURGERY OF TULSA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABBAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TOUGHANIPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-869-7013
Mailing Address - Street 1:238 N MIDWEST BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4311
Mailing Address - Country:US
Mailing Address - Phone:405-869-7013
Mailing Address - Fax:405-737-0912
Practice Address - Street 1:238 N MIDWEST BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4311
Practice Address - Country:US
Practice Address - Phone:405-869-7013
Practice Address - Fax:405-737-0912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK215502086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty