Provider Demographics
NPI:1588825590
Name:SHADID, ANNA LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:LEIGH
Last Name:SHADID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANNA
Other - Middle Name:LEIGH
Other - Last Name:SHADID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1114 TEDFORD WAY
Mailing Address - Street 2:
Mailing Address - City:NICHOLS HILLS
Mailing Address - State:OK
Mailing Address - Zip Code:73116-6007
Mailing Address - Country:US
Mailing Address - Phone:405-826-3662
Mailing Address - Fax:
Practice Address - Street 1:4200 W MEMORIAL RD STE 212
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8305
Practice Address - Country:US
Practice Address - Phone:405-752-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ56702085R0202X
OK265072085R0202X
OH351210892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100240660Medicaid
OH0083321Medicaid
IN201168140Medicaid
OHH193161Medicare PIN