Provider Demographics
NPI:1992718381
Name:AMAYEM, AHMED A (MD)
Entity type:Individual
Prefix:DR
First Name:AHMED
Middle Name:A
Last Name:AMAYEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1145 W I 240 SERVICE RD
Mailing Address - Street 2:BUILDING I SUITE 100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2134
Mailing Address - Country:US
Mailing Address - Phone:405-632-1783
Mailing Address - Fax:405-631-0508
Practice Address - Street 1:1145 W I 240 SERVICE RD
Practice Address - Street 2:BUILDING # I
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2134
Practice Address - Country:US
Practice Address - Phone:405-632-1783
Practice Address - Fax:405-631-0508
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK19121208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100260160BMedicaid
OK100260160BMedicaid
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