Provider Demographics
NPI:1235186099
Name:SIRAJUDDIN, RIAZ AHMED (MD)
Entity Type:Individual
Prefix:DR
First Name:RIAZ
Middle Name:AHMED
Last Name:SIRAJUDDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RIAZ
Other - Middle Name:AHMED
Other - Last Name:SIRAJUDDIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10413 GREENBRIAR PARKWAY
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-6923
Mailing Address - Country:US
Mailing Address - Phone:405-691-4665
Mailing Address - Fax:405-378-7628
Practice Address - Street 1:10413 GREENBRIAR PKWY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7656
Practice Address - Country:US
Practice Address - Phone:405-691-4665
Practice Address - Fax:405-378-7628
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22726174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG75620Medicare UPIN