Provider Demographics
NPI:1225210248
Name:AKRAM R. ABRAHAM, M.D.PC
Entity Type:Organization
Organization Name:AKRAM R. ABRAHAM, M.D.PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AKRAM
Authorized Official - Middle Name:RAMSY
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-688-2200
Mailing Address - Street 1:920 N 8TH ST
Mailing Address - Street 2:PO BOX 431
Mailing Address - City:HOLLIS
Mailing Address - State:OK
Mailing Address - Zip Code:73550-2026
Mailing Address - Country:US
Mailing Address - Phone:580-688-2200
Mailing Address - Fax:580-688-2229
Practice Address - Street 1:920 N 8TH ST
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:OK
Practice Address - Zip Code:73550-2026
Practice Address - Country:US
Practice Address - Phone:580-688-2200
Practice Address - Fax:580-688-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100034510EMedicaid
OK100034510EMedicaid