Provider Demographics
NPI:1013040898
Name:MIDWEST NEPHROLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:MIDWEST NEPHROLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WUDENEH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEWDIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-737-4900
Mailing Address - Street 1:1201 S DOUGLAS BLVD STE K
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-5263
Mailing Address - Country:US
Mailing Address - Phone:405-737-4900
Mailing Address - Fax:405-737-3606
Practice Address - Street 1:1201 S DOUGLAS BLVD STE K
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5263
Practice Address - Country:US
Practice Address - Phone:405-737-4900
Practice Address - Fax:405-737-3606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24328207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty