Provider Demographics
NPI:1619711512
Name:TULSA CARDIOLOGY CLINIC
Entity type:Organization
Organization Name:TULSA CARDIOLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAWAD
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-880-5600
Mailing Address - Street 1:2100 S UTICA AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1437
Mailing Address - Country:US
Mailing Address - Phone:918-932-3836
Mailing Address - Fax:918-203-0027
Practice Address - Street 1:2100 S UTICA AVE STE 202
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1437
Practice Address - Country:US
Practice Address - Phone:918-932-3836
Practice Address - Fax:918-203-0027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-24
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK201302020AMedicaid