Provider Demographics
NPI:1770055337
Name:FM ORTHOPEDICS LLC
Entity type:Organization
Organization Name:FM ORTHOPEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MUNAWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-210-0040
Mailing Address - Street 1:17861 PRAIRIE SKY WAY
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-6628
Mailing Address - Country:US
Mailing Address - Phone:580-210-0040
Mailing Address - Fax:405-330-9082
Practice Address - Street 1:17861 PRAIRIE SKY WAY
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-6628
Practice Address - Country:US
Practice Address - Phone:580-210-0040
Practice Address - Fax:405-330-9082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-20
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200524500AMedicaid