Basic Information
| Provider Information | |||||||||
| NPI: | 1861732992 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLASSEN FAMILY PRACTICE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2824 CLASSEN BLVD | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730714059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057017111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2824 CLASSEN BLVD | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730714059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057013563 | ||||||||
| FaxNumber: | 4053105194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2013 | ||||||||
| LastUpdateDate: | 07/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | TORBATI | ||||||||
| AuthorizedOfficialFirstName: | HUSSEIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 4057017111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.