Provider Demographics
NPI:1245237312
Name:ARABOLU, BALA KRISHNA V (MD)
Entity Type:Individual
Prefix:DR
First Name:BALA KRISHNA
Middle Name:V
Last Name:ARABOLU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 N 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2122
Mailing Address - Country:US
Mailing Address - Phone:580-924-1144
Mailing Address - Fax:580-924-6667
Practice Address - Street 1:1202 N 16TH AVE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2122
Practice Address - Country:US
Practice Address - Phone:580-924-1144
Practice Address - Fax:580-924-6667
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11709208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100019390AMedicaid
OK100019390CMedicaid
TX0741308-01Medicaid