Organization
INNOVATIVE MEDICAL ASSOCIATES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VATSALA SHAH MD (MANAGING PARTNER)
(405) 553-1540
Entity
Organization
Contact information
Practice address
4301 NW 63RD ST, SUITE 205, OKLAHOMA CITY, OK 73116-1549
(405) 242-6494
(405) 242-6496
Mailing address
1225 W MAIN ST, SUITE 205, NORMAN, OK 73069-6824
(405) 292-5500
(405) 292-5505
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100748720A
—
OK
Enumeration date
05/23/2007
Last updated
01/07/2016
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