Provider Demographics
NPI:1073836532
Name:ADEL R MALATI, M.D., INC.
Entity Type:Organization
Organization Name:ADEL R MALATI, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEL
Authorized Official - Middle Name:RAMZI
Authorized Official - Last Name:MALATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-756-2800
Mailing Address - Street 1:1201 S BELMONT AVE
Mailing Address - Street 2:SUITE #101
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-6351
Mailing Address - Country:US
Mailing Address - Phone:918-756-2800
Mailing Address - Fax:918-756-2861
Practice Address - Street 1:1201 S BELMONT AVE
Practice Address - Street 2:SUITE #101
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6351
Practice Address - Country:US
Practice Address - Phone:918-756-2800
Practice Address - Fax:918-756-2861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18853261QM2500X
OH35067408261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100120460BMedicaid
OK100120460DMedicaid
OK100120460DMedicaid