Provider Demographics
NPI:1306396775
Name:MIDWEST NEPHROLOGY GROUP PLLC
Entity Type:Organization
Organization Name:MIDWEST NEPHROLOGY GROUP PLLC
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 1:9230 E RENO AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-3337
Mailing Address - Country:US
Mailing Address - Phone:405-737-4900
Mailing Address - Fax:405-737-3606
Practice Address - Street 1:9230 E RENO AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-3337
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:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty