1861587289 NPI number — NIDHI KOUL M.D.

Table of content: NIDHI KOUL M.D. (NPI 1861587289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861587289 NPI number — NIDHI KOUL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOUL
Provider First Name:
NIDHI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1861587289
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2617 S. ELM PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROKEN ARROW
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74012-7850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-455-6980
Provider Business Mailing Address Fax Number:
918-449-9749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2617 S. ELM PLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROKEN ARROW
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74012-7850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-455-6980
Provider Business Practice Location Address Fax Number:
918-449-9749
Provider Enumeration Date:
10/03/2006

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:  224299 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1300172 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 486892 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0036582 . This is a "NHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 200222490A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: J29428 . This is a "BC BS OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA40070 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3986470 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 412987 . This is a "BC BS OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 000000031938 . This is a "BMC HEALTHNET PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 89793 . This is a "CMSP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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