Provider Demographics
NPI:1205836491
Name:ADHAM, MEHDI NAVID (MD)
Entity Type:Individual
Prefix:
First Name:MEHDI
Middle Name:NAVID
Last Name:ADHAM
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 1:8100 S WALKER AVE
Mailing Address - Street 2:BLGD A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-9402
Mailing Address - Country:US
Mailing Address - Phone:405-632-4468
Mailing Address - Fax:405-631-4964
Practice Address - Street 1:8100 S WALKER AVE BLDG A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9475
Practice Address - Country:US
Practice Address - Phone:405-632-4468
Practice Address - Fax:405-632-0436
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK139132082S0099X, 202C00000X, 2082S0105X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK13913OtherMEDICAL LICENSE
OK245527704Medicare ID - Type Unspecified