Provider Demographics
NPI:1699237891
Name:MUMTAZ, AHMAD (MBBS)
Entity type:Individual
Prefix:MR
First Name:AHMAD
Middle Name:
Last Name:MUMTAZ
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6600 S YALE AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3331
Mailing Address - Country:US
Mailing Address - Phone:888-247-0125
Mailing Address - Fax:918-502-8210
Practice Address - Street 1:6565 S YALE AVE STE 209
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8303
Practice Address - Country:US
Practice Address - Phone:918-488-0990
Practice Address - Fax:918-728-8036
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361650942084N0400X
OK431372084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology