Individual
DR. HAYSAM GHANNOUM
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1145 S UTICA AVE, STE 1105, TULSA, OK 74104-4000
(918) 579-5724
(918) 560-5791
Mailing address
1611 S UTICA AVE, # 414, TULSA, OK 74104-4909
(918) 579-5724
(918) 560-5791
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
21933
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00096057
RAILROAD MEDICARE PIN
OK
Enumeration date
05/27/2006
Last updated
07/09/2007
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