Healthcare Provider Details

I. General information

NPI: 1538121421
Provider Name (Legal Business Name): WUDENEH ZEWDIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9230 E RENO AVE SUITE - B
MIDWEST CITY OK
73130-3320
US

IV. Provider business mailing address

9230 E RENO AVE SUITE - B
MIDWEST CITY OK
73130-3320
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 Number24328
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: