Healthcare Provider Details

I. General information

NPI: 1710816673
Provider Name (Legal Business Name): MADINA MEDICAL GROUP PC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W 18TH ST STE 140
EDMOND OK
73013-3759
US

IV. Provider business mailing address

209 NW 151ST ST
EDMOND OK
73013-1736
US

V. Phone/Fax

Practice location:
  • Phone: 716-238-1473
  • Fax:
Mailing address:
  • Phone: 716-238-1473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: TALAL ALI KHAN
Title or Position: OWNER
Credential: M.D
Phone: 716-238-1473