Provider Demographics
NPI:1982072914
Name:PANKAJ BALUJA PLLC
Entity type:Organization
Organization Name:PANKAJ BALUJA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PANKAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:BALUJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-272-8367
Mailing Address - Street 1:810 NW 10TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-7215
Mailing Address - Country:US
Mailing Address - Phone:405-272-8367
Mailing Address - Fax:405-272-8373
Practice Address - Street 1:810 NW 10TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-7215
Practice Address - Country:US
Practice Address - Phone:405-272-8367
Practice Address - Fax:405-272-8373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22892174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty