Basic Information
| Provider Information | |||||||||
| NPI: | 1568413284 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AMIL | ||||||||
| FirstName: | AZHAR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3433 NW 56TH ST STE 400 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731124430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059473341 | ||||||||
| FaxNumber: | 4059173590 | ||||||||
| Practice Location | |||||||||
| Address1: | 13720 N BRYANT AVE | ||||||||
| Address2: | |||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730136464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054785222 | ||||||||
| FaxNumber: | 4054785883 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 04/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 12579 | OK | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 100226600B | 05 | OK | MEDICAID |