Provider Demographics
NPI:1932406311
Name:KEITA, NABIL ISSOUF SAID (MS)
Entity Type:Individual
Prefix:
First Name:NABIL
Middle Name:ISSOUF SAID
Last Name:KEITA
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:NABIL
Other - Middle Name:I
Other - Last Name:KEITA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10023 E 40TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-2420
Mailing Address - Country:US
Mailing Address - Phone:918-955-8094
Mailing Address - Fax:
Practice Address - Street 1:10023 E 40TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-2420
Practice Address - Country:US
Practice Address - Phone:918-955-8094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK452587247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist