Provider Demographics
NPI:1326389842
Name:CRONUS PLLC
Entity Type:Organization
Organization Name:CRONUS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARSHID
Authorized Official - Middle Name:
Authorized Official - Last Name:ZANDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-299-8232
Mailing Address - Street 1:PO BOX 4769
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74159-0769
Mailing Address - Country:US
Mailing Address - Phone:918-299-8232
Mailing Address - Fax:
Practice Address - Street 1:1815 E 15TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4610
Practice Address - Country:US
Practice Address - Phone:918-299-8232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22558207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100204720AMedicaid
OK233721401Medicare PIN