Provider Demographics
NPI:1790816700
Name:BALOGUN, SEKI A (MD)
Entity Type:Individual
Prefix:
First Name:SEKI
Middle Name:A
Last Name:BALOGUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 STANTON L YOUNG BLVD STE 2410
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5036
Mailing Address - Country:US
Mailing Address - Phone:405-271-8558
Mailing Address - Fax:405-271-3887
Practice Address - Street 1:825 NE 10TH ST STE 4F
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5417
Practice Address - Country:US
Practice Address - Phone:405-271-8558
Practice Address - Fax:405-271-3887
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK38433207RG0300X
VA0101231678207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005882630Medicaid
VAH81379Medicare UPIN
VA001209U01Medicare PIN