Provider Demographics
NPI:1184631756
Name:BAHA AL DEEN ABUESHEH MD PC
Entity Type:Organization
Organization Name:BAHA AL DEEN ABUESHEH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BAHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABUESHEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-223-0447
Mailing Address - Street 1:PO BOX 268996
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8996
Mailing Address - Country:US
Mailing Address - Phone:580-223-0447
Mailing Address - Fax:580-223-2989
Practice Address - Street 1:1219 A K STREET NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1801
Practice Address - Country:US
Practice Address - Phone:580-223-0447
Practice Address - Fax:580-223-2989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK224412084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200096350AMedicaid
OK200522113Medicare PIN