Provider Demographics
NPI:1851581185
Name:ATTALLAH-WASIF, EMAD SAMIR (MD)
Entity Type:Individual
Prefix:DR
First Name:EMAD
Middle Name:SAMIR
Last Name:ATTALLAH-WASIF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10124 S SHERIDAN RD
Mailing Address - Street 2:STE B
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6742
Mailing Address - Country:US
Mailing Address - Phone:774-473-9119
Mailing Address - Fax:877-220-3112
Practice Address - Street 1:10124 S SHERIDAN RD
Practice Address - Street 2:STE B
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6742
Practice Address - Country:US
Practice Address - Phone:774-473-9119
Practice Address - Fax:877-220-3112
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK31431207LP2900X, 207LP2900X
MA235854207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200593270AMedicaid