Provider Demographics
NPI:1932299500
Name:BISSADA, NABIL KADDIS (MD)
Entity Type:Individual
Prefix:DR
First Name:NABIL
Middle Name:KADDIS
Last Name:BISSADA
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 1:920 STANTON L. YOUNG BOULEVARD
Mailing Address - Street 2:WP3150
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104
Mailing Address - Country:US
Mailing Address - Phone:405-271-6900
Mailing Address - Fax:405-271-3118
Practice Address - Street 1:825 N.E. 10TH STREET
Practice Address - Street 2:SUITE 5400
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-271-6452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-2121208800000X
OK29007208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148787001Medicaid
B91444Medicare UPIN
5M404Medicare PIN
AR148787001Medicaid