Organization
INTERNAL MEDICINE & NEPHROLOGY ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMMAD FAZEL KHALILI M.D. (OWNER)
(405) 340-4565
Entity
Organization
Contact information
Practice address
105 S BRYANT AVE, 202, EDMOND, OK 73034-6399
(405) 340-4565
(405) 340-4583
Mailing address
105 S BRYANT AVE, 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
—
342965190002
BLUE CROSS BLUE SHIELD
OK
Enumeration date
05/25/2006
Last updated
08/22/2020
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