Provider Demographics
NPI:1962695213
Name:NORMAN INTERNAL MEDICINE, P.C.
Entity type:Organization
Organization Name:NORMAN INTERNAL MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHSAVARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-573-7800
Mailing Address - Street 1:3101 W TECUMSEH RD STE 106
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-1816
Mailing Address - Country:US
Mailing Address - Phone:405-573-7800
Mailing Address - Fax:405-573-7810
Practice Address - Street 1:3101 W TECUMSEH RD STE 103
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-1816
Practice Address - Country:US
Practice Address - Phone:405-573-7800
Practice Address - Fax:405-573-7810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21906174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1255361648OtherNPI
OK1962695213OtherGROUP NPI
OK100225100AMedicaid
OK37D0988996OtherCLIA
OK100225100AMedicaid
OK625045061RMedicare PIN