1245237312 NPI number — DR. BALA KRISHNA V ARABOLU M.D.

Table of content: DR. BALA KRISHNA V ARABOLU M.D. (NPI 1245237312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245237312 NPI number — DR. BALA KRISHNA V ARABOLU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARABOLU
Provider First Name:
BALA KRISHNA
Provider Middle Name:
V
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245237312
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1202 N 16TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURANT
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74701-2122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-924-1144
Provider Business Mailing Address Fax Number:
580-924-6667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1202 N 16TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURANT
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74701-2122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-924-1144
Provider Business Practice Location Address Fax Number:
580-924-6667
Provider Enumeration Date:
07/05/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  11709 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100019390A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100019390C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0741308-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".