Organization
NEUROLOGY CARE, PC
Active
Organization
NEUROLOGY CARE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ARVO KANNA (MD)
(580) 226-5775
Entity
Organization
Contact information
Practice address
1115 WALNUT DR, ARDMORE, OK 73401-2354
(580) 226-5775
(580) 226-5743
Mailing address
1115 WALNUT DR, ARDMORE, OK 73401-2354
(580) 226-5775
(580) 226-5743
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
23163
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
$$$$$$$$$
SSN #
OK
05
—
20003140A
—
OK
01
—
23163
OK LICENSE #
OK
01
—
548436293001
BCBS 12 DIGIT #
OK
Enumeration date
09/02/2006
Last updated
08/22/2020
Update your record
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