Provider Demographics
NPI:1366564304
Name:ABOUHOULI, HASSAN AWAD (MD)
Entity type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:AWAD
Last Name:ABOUHOULI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1245 S UTICA AVE
Mailing Address - Street 2:STE 330
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4214
Mailing Address - Country:US
Mailing Address - Phone:918-382-6540
Mailing Address - Fax:918-382-2560
Practice Address - Street 1:1245 S UTICA AVE
Practice Address - Street 2:STE 330
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4214
Practice Address - Country:US
Practice Address - Phone:918-382-6540
Practice Address - Fax:918-382-2560
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125047898207R00000X
OK25636207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200113080AMedicaid
OKOKA104295Medicare PIN