Basic Information
| Provider Information | |||||||||
| NPI: | 1821079500 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NARULA | ||||||||
| FirstName: | RAJESH | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 500 W BROADWAY ST 4TH FLOOR | ||||||||
| Address2: | PROVIDENCE NEPH OF MT | ||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598024096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063271918 | ||||||||
| FaxNumber: | 4065492246 | ||||||||
| Practice Location | |||||||||
| Address1: | 1380 S DOUGLAS BLVD | ||||||||
| Address2: | |||||||||
| City: | MIDWEST CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731305215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057370881 | ||||||||
| FaxNumber: | 4057370899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 06/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 207RN0300X | OK | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 100017630A | 05 | OK | MEDICAID | 200028420A | 05 | OK | MEDICAID | 731570351-001 | 01 | OK | BCBS DR PROVIDER | OTHER | 731602722-001 | 01 | OK | BCBS GROUP ID | OTHER |