Provider Demographics
NPI:1538121421
Name:ZEWDIE, WUDENEH (MD)
Entity Type:Individual
Prefix:DR
First Name:WUDENEH
Middle Name:
Last Name:ZEWDIE
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 1:9230 E RENO AVE
Mailing Address - Street 2:SUITE - B
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-3320
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:73130-3320
Practice Address - Country:US
Practice Address - Phone:405-737-4900
Practice Address - Fax:405-737-3606
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24328207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200059780AMedicaid
OK200059780AMedicaid
OKI37255Medicare UPIN