MEDICARE: MADINA MEDICAL GROUP PC INC

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	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1710816673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADINA MEDICAL GROUP PC INC

Provider Business Mailing Address
First Line	:	209 NW 151ST ST
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-1736
Country	:	US
Telephone Number	:	716-238-1473
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 W 18TH ST STE 140
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-3759
Country	:	US
Telephone Number	:	716-238-1473
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TALAL ALI KHAN
Credential	:	M.D
Telephone Number	:	716-238-1473

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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