Provider Demographics
NPI:1649834060
Name:GRUHONJIC, IMRAN (DO)
Entity type:Individual
Prefix:
First Name:IMRAN
Middle Name:
Last Name:GRUHONJIC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 N DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2609
Mailing Address - Country:US
Mailing Address - Phone:405-979-7854
Mailing Address - Fax:405-979-7859
Practice Address - Street 1:1111 N DEWEY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2609
Practice Address - Country:US
Practice Address - Phone:405-979-7854
Practice Address - Fax:405-979-7859
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A22681207X00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program