Provider Demographics
NPI:1205909215
Name:BALA KRISHNA V ARABOLU
Entity type:Organization
Organization Name:BALA KRISHNA V ARABOLU
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BALA KRISHNA
Authorized Official - Middle Name:V
Authorized Official - Last Name:ARABOLU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-924-1144
Mailing Address - Street 1:1202 N 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2122
Mailing Address - Country:US
Mailing Address - Phone:580-924-1144
Mailing Address - Fax:580-924-6667
Practice Address - Street 1:1202 N 16TH AVE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2122
Practice Address - Country:US
Practice Address - Phone:580-924-1144
Practice Address - Fax:580-924-6667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11709208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100741720AMedicaid