Healthcare Provider Details

I. General information

NPI: 1205909215
Provider Name (Legal Business Name): BALA KRISHNA V ARABOLU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 N 16TH AVE
DURANT OK
74701-2122
US

IV. Provider business mailing address

1202 N 16TH AVE
DURANT OK
74701-2122
US

V. Phone/Fax

Practice location:
  • Phone: 580-924-1144
  • Fax: 580-924-6667
Mailing address:
  • Phone: 580-924-1144
  • Fax: 580-924-6667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11709
License Number StateOK

VIII. Authorized Official

Name: MRS. BALA KRISHNA V ARABOLU
Title or Position: DOCTOR
Credential: M.D.
Phone: 580-924-1144