Individual
MOHAMMAD FAZEL KHALILI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
105 S BRYANT AVE, SUITE 202, EDMOND, OK 73034-6399
(405) 340-4565
(405) 340-4583
Mailing address
105 S BRYANT AVE, SUITE 202, EDMOND, OK 73034-6399
(405) 340-4565
(405) 340-4583
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
23879
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23879
MEDICAL LICENSE
OK
Enumeration date
06/10/2006
Last updated
07/09/2007
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