Healthcare Provider Details

I. General information

NPI: 1114612900
Provider Name (Legal Business Name): BILASH POUDEL MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 S UTICA AVE
TULSA OK
74104-6520
US

IV. Provider business mailing address

1722 S CARSON AVE APT 1002
TULSA OK
74119-4640
US

V. Phone/Fax

Practice location:
  • Phone: 347-401-1750
  • Fax:
Mailing address:
  • Phone: 347-401-1750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number46665
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: