Provider Demographics
NPI:1760030399
Name:OPTIMUM PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:OPTIMUM PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SANAULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-359-5370
Mailing Address - Street 1:105 S BRYANT AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6330
Mailing Address - Country:US
Mailing Address - Phone:405-359-5370
Mailing Address - Fax:405-359-5481
Practice Address - Street 1:105 S BRYANT AVE STE 108
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6330
Practice Address - Country:US
Practice Address - Phone:405-359-5370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-27
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Multi-Specialty