Individual
MASOOD GHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
430 N MONTE VISTA ST, ADA, OK 74820-4610
(580) 421-1141
Mailing address
430 N MONTE VISTA ST, ADA, OK 74820-4610
(580) 421-1141
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
036129177
IL
207RH0003X
Hematology & Oncology Physician
Primary
8789
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036129177
—
IL
01
—
F400194061
MEDICARE PTAN
IL
Enumeration date
08/26/2007
Last updated
08/13/2025
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