Provider Demographics
NPI:1477714590
Name:KASH K. BIDDLE, DO, PLLC
Entity Type:Organization
Organization Name:KASH K. BIDDLE, DO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KASH
Authorized Official - Middle Name:K
Authorized Official - Last Name:BIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-455-2416
Mailing Address - Street 1:3300 S ASPEN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7501
Mailing Address - Country:US
Mailing Address - Phone:918-455-2416
Mailing Address - Fax:918-455-7546
Practice Address - Street 1:3300 S ASPEN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7501
Practice Address - Country:US
Practice Address - Phone:918-455-2416
Practice Address - Fax:918-455-7546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2152207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100145710AMedicaid
OK100145710AMedicaid
OKE45396Medicare UPIN