Healthcare Provider Details

I. General information

NPI: 1063725901
Provider Name (Legal Business Name): BILAL AZIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 11/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1373 E BOONE ST SUITE 1201
TAHLEQUAH OK
74464-3364
US

IV. Provider business mailing address

1373 E BOONE ST SUITE 1201
TAHLEQUAH OKLAHOMA
74464
UM

V. Phone/Fax

Practice location:
  • Phone: 918-207-1189
  • Fax: 918-207-1160
Mailing address:
  • Phone: 918-207-1189
  • Fax: 918-207-1160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29521
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number29521
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: