Provider Demographics
NPI:1306841903
Name:SERADGE, HOUSHANG (MD)
Entity Type:Individual
Prefix:
First Name:HOUSHANG
Middle Name:
Last Name:SERADGE
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:PO BOX 26706
Mailing Address - Street 2:SECTION 4135
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-0706
Mailing Address - Country:US
Mailing Address - Phone:405-634-4263
Mailing Address - Fax:405-634-4287
Practice Address - Street 1:1044 SW 44TH ST
Practice Address - Street 2:SUITE 518
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3613
Practice Address - Country:US
Practice Address - Phone:405-634-4263
Practice Address - Fax:405-634-4267
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12474207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK990009843OtherMEDICARE RAILROAD
OKC95465Medicare UPIN