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General NPI Number Information
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NPI Number | 1619923281
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE & NEPHROLOGY ASSOCIATES, PC
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 105 S BRYANT AVE 202
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City | EDMOND
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State | OK
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Zip | 73034-6399
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Country | US
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Telephone | 405-340-4565
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Fax | 405-340-4583
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Provider Business Mailing Address
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Address Line | 105 S BRYANT AVE 202
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City | EDMOND
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State | OK
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Zip | 73034-6399
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Country | US
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Telephone | 405-340-4565
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Fax | 405-340-4583
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMMAD FAZEL KHALILI
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Credential | M.D.
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Telephone | 405-340-4565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 23879
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License Number State | OK
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