Provider Demographics
NPI:1134102916
Name:GHANI, MOHAMMAD KHALED JAMEL (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:KHALED JAMEL
Last Name:GHANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 NW 85TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-3385
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4050 W MEMORIAL RD FL 3
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8382
Practice Address - Country:US
Practice Address - Phone:405-608-3800
Practice Address - Fax:405-608-3910
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36097360207RC0000X, 207RI0011X
TXK8755207RI0011X, 207RC0000X
OK22744207RI0011X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00306721OtherRAILROAD MEDICARE
OK100847690AMedicaid
A013421562OtherVISA
OKP00306721OtherRAILROAD MEDICARE
OKOKA100620Medicare PIN
A013421562OtherVISA