Healthcare Provider Details

I. General information

NPI: 1922647585
Provider Name (Legal Business Name): COMPLETE & COMPREHENSIVE KIDNEY CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2019
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 NW 10TH ST STE A
OKLAHOMA CITY OK
73106-7216
US

IV. Provider business mailing address

PO BOX 268946
OKLAHOMA CITY OK
73126-8946
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-8367
  • Fax:
Mailing address:
  • Phone: 405-691-4703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TARIQ A KHAN
Title or Position: CEO
Credential: MD
Phone: 314-629-8948