Provider Demographics
NPI:1891097358
Name:LIAQAT, KHURRAM (MD)
Entity Type:Individual
Prefix:MR
First Name:KHURRAM
Middle Name:
Last Name:LIAQAT
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 1:539 85TH ST APT 5D
Mailing Address - Street 2:BROOKLYN
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4830
Mailing Address - Country:US
Mailing Address - Phone:917-443-0950
Mailing Address - Fax:
Practice Address - Street 1:9020 E RENO AVE STE 200
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-3336
Practice Address - Country:US
Practice Address - Phone:917-443-0950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI71637207RI0011X
OK33037207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200104630Medicaid