Provider Demographics
NPI:1881662252
Name:KHORASANCHIAN, ABDOLKARIM (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDOLKARIM
Middle Name:
Last Name:KHORASANCHIAN
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 1:1101 E WADE WATTS AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5625
Mailing Address - Country:US
Mailing Address - Phone:918-426-4900
Mailing Address - Fax:918-423-1803
Practice Address - Street 1:1101 E WADE WATTS AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5625
Practice Address - Country:US
Practice Address - Phone:918-426-4900
Practice Address - Fax:918-423-1803
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12251174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist