Healthcare Provider Details

I. General information

NPI: 1306396775
Provider Name (Legal Business Name): MIDWEST NEPHROLOGY GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9230 E RENO AVE SUITE B
MIDWEST CITY OK
73130-3337
US

IV. Provider business mailing address

9230 E RENO AVE SUITE B
MIDWEST CITY OK
73130-3337
US

V. Phone/Fax

Practice location:
  • Phone: 405-737-4900
  • Fax: 405-737-3606
Mailing address:
  • Phone: 405-737-4900
  • Fax: 405-737-3606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. WUDENEH ZEWDIE
Title or Position: PRESIDENT
Credential: M.D.,
Phone: 405-737-4900