Provider Demographics
NPI:1235477548
Name:INTERNAL MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIEUHAN
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:405-604-0688
Mailing Address - Street 1:3330 NW 56TH ST STE 208
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4426
Mailing Address - Country:US
Mailing Address - Phone:405-604-0688
Mailing Address - Fax:405-604-0689
Practice Address - Street 1:3330 NW 56TH ST STE 208
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4426
Practice Address - Country:US
Practice Address - Phone:405-604-0688
Practice Address - Fax:405-604-0689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKAPA2216207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty