Individual
KAVEH KERMANSHAHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10507 E 91ST ST, SUITE 310, TULSA, OK 74133-5790
(918) 307-3200
(918) 307-3210
Mailing address
10507 E 91ST ST, SUITE 310, TULSA, OK 74133-5589
(918) 307-3200
(918) 307-3209
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
17717
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100103360A
—
OK
Enumeration date
01/27/2006
Last updated
06/17/2015
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