Organization
SOUTHSIDE UROLOGY CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAJENDRA K MOTWANI D.O. (OWNER)
(405) 632-4500
Entity
Organization
Contact information
Practice address
9817 S WESTERN AVE, OKLAHOMA CITY, OK 73139-2812
(405) 632-4500
(405) 632-7500
Mailing address
9817 S WESTERN AVE, OKLAHOMA CITY, OK 73139-2812
(405) 632-4500
(405) 632-7500
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
3478
OK
261QM2500X
Medical Specialty Clinic/Center
3478
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200620340A
—
OK
Enumeration date
02/27/2008
Last updated
07/25/2016
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