Provider Demographics
NPI:1700078797
Name:KHALID, MANSOOR (MD)
Entity Type:Individual
Prefix:DR
First Name:MANSOOR
Middle Name:
Last Name:KHALID
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 1:3366 NW EXPRESSWAY STE 550
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4489
Mailing Address - Country:US
Mailing Address - Phone:405-942-5442
Mailing Address - Fax:405-942-6448
Practice Address - Street 1:3366 NW EXPRESSWAY STE 550
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4489
Practice Address - Country:US
Practice Address - Phone:405-942-5442
Practice Address - Fax:405-942-6448
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25798207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKA100480Medicare PIN