| Primarypractice LLC | |
|
1125 N Porter Ave Ste 101 Norman OK 73071-6443 | |
| (405) 364-0630 | |
| (405) 364-0760 |
| Full Name | Primarypractice LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 1125 N Porter Ave Ste 101, Norman, Oklahoma |
| Authorized Official Name and Position | Kumar B Ennamuri (OWNER/PRESIDENT) |
| Authorized Official Contact | 4058202586 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Primarypractice LLC 1125 N Porter Ave Ste 101 Norman OK 73071-6443 Ph: (405) 364-0630 | Primarypractice LLC 1125 N Porter Ave Ste 101 Norman OK 73071-6443 Ph: (405) 364-0630 |
| NPI Number | 1932787926 |
|---|---|
| Provider Enumeration Date | 03/31/2021 |
| Last Update Date | 03/31/2021 |
| Certification Date | 03/31/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932787926 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
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