Provider Demographics
NPI:1710416573
Name:UNIVERSAL KIDNEY CARE OF OKLAHOMA PLLC
Entity Type:Organization
Organization Name:UNIVERSAL KIDNEY CARE OF OKLAHOMA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BALIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-417-8573
Mailing Address - Street 1:1605 NW 176TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-6910
Mailing Address - Country:US
Mailing Address - Phone:405-417-8573
Mailing Address - Fax:405-936-0561
Practice Address - Street 1:5300 N INDEPENDENCE AVE STE 280
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5555
Practice Address - Country:US
Practice Address - Phone:405-936-0504
Practice Address - Fax:405-936-0561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26355207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty