1821079500 NPI number — DR. RAJESH K NARULA M.D.

Table of content: DR. RAJESH K NARULA M.D. (NPI 1821079500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821079500 NPI number — DR. RAJESH K NARULA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NARULA
Provider First Name:
RAJESH
Provider Middle Name:
K
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:
1821079500
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 W BROADWAY ST 4TH FLOOR
Provider Second Line Business Mailing Address:
PROVIDENCE NEPH OF MT
Provider Business Mailing Address City Name:
MISSOULA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59802-4096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-327-1918
Provider Business Mailing Address Fax Number:
406-549-2246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1380 S DOUGLAS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDWEST CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73130-5215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-737-0881
Provider Business Practice Location Address Fax Number:
405-737-0899
Provider Enumeration Date:
11/09/2005

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: 207RN0300X , with the licence number:  207RN0300X , 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: 100017630A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200028420A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 731570351-001 . This is a "BCBS DR PROVIDER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 731602722-001 . This is a "BCBS GROUP ID" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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