Provider Demographics
NPI:1134325871
Name:MARK C. NAHMIAS, DPM, PLLC
Entity type:Organization
Organization Name:MARK C. NAHMIAS, DPM, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:NAHMIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:918-749-9996
Mailing Address - Street 1:5906 E 31ST ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-5110
Mailing Address - Country:US
Mailing Address - Phone:918-749-9996
Mailing Address - Fax:918-622-9998
Practice Address - Street 1:5906 E 31ST ST
Practice Address - Street 2:SUITE 1
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5110
Practice Address - Country:US
Practice Address - Phone:918-749-9996
Practice Address - Fax:918-622-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK166213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKT14987Medicare UPIN
OK6228170001Medicare NSC
OK300522065Medicare ID - Type UnspecifiedPLLC