MEDICARE: EKTA W AHLUWALIA PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	673	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	445401657-002	OTHER	OK	BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457396210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EKTA W AHLUWALIA PH.D.

Provider Business Mailing Address
First Line	:	9641 CASTLE RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-7217
Country	:	US
Telephone Number	:	405-721-0168
Fax Number	:

Provider Business Practice Location Address
First Line	:	9641 CASTLE RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-7217
Country	:	US
Telephone Number	:	405-721-0168
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	11/15/2013

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