Provider Demographics
NPI:1770773491
Name:HALLERAN, SEAN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:MICHAEL
Last Name:HALLERAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3433 NW 56TH ST
Mailing Address - Street 2:STE 400
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4455
Mailing Address - Country:US
Mailing Address - Phone:405-947-3341
Mailing Address - Fax:405-951-4342
Practice Address - Street 1:3433 NW 56TH ST
Practice Address - Street 2:STE 400
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4455
Practice Address - Country:US
Practice Address - Phone:405-947-3341
Practice Address - Fax:405-951-4342
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01067190A207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200956430Medicaid
OK200474350AMedicaid
OK272906YPN3Medicare PIN