Organization
CHRISTIAN CARDIOVASCULAR INSTITUTE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOMINIC M. PEDULLA M.D. (PRESIDENT)
(405) 947-2228
Entity
Organization
Contact information
Practice address
3300 NW 56TH STREET, SUITE 200, OKLAHOMA CITY, OK 73112-4401
(405) 947-2228
(405) 947-2307
Mailing address
3300 NW 56TH STREET, SUITE 200, OKLAHOMA CITY, OK 73112-4401
(405) 947-2228
(405) 947-2307
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
17642
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10012360A
—
OK
01
—
DP6097
RAILROAD MEDICARE
—
Enumeration date
04/07/2008
Last updated
02/19/2018
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