Provider Demographics
NPI:1245324433
Name:KESSERWAN, RADWAN (MD)
Entity type:Individual
Prefix:MR
First Name:RADWAN
Middle Name:
Last Name:KESSERWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:RADWAN
Other - Middle Name:AH
Other - Last Name:KESSERWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:608 N.W. 9TH STREET
Mailing Address - Street 2:SUITE 6105
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1006
Mailing Address - Country:US
Mailing Address - Phone:405-231-3841
Mailing Address - Fax:405-231-3705
Practice Address - Street 1:608 N.W. 9TH STREET
Practice Address - Street 2:SUITE 6105
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1006
Practice Address - Country:US
Practice Address - Phone:405-231-3841
Practice Address - Fax:405-231-3705
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22414207R00000X, 207RC0000X, 207RI0001X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200407290AMedicaid