Provider Demographics
NPI:1548391097
Name:JANJUA, NADIA KHAN (MD)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:KHAN
Last Name:JANJUA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NADIA
Other - Middle Name:IMTIAZ
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6600 S YALE AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3331
Mailing Address - Country:US
Mailing Address - Phone:888-247-0125
Mailing Address - Fax:918-502-8001
Practice Address - Street 1:6161 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1902
Practice Address - Country:US
Practice Address - Phone:918-494-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40982207R00000X
OK28358207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200396080AMedicaid
096167OtherSIHO/NORTON
1887242OtherCIGNA/NORTON
000000564610OtherANTHEM/NORTON
KY7100024180Medicaid
000023033LOtherHUMANA/NORTON
200894190OtherIN MAID/NORTON
KY0912005Medicare PIN
096167OtherSIHO/NORTON