MEDICARE: ACCESS ENDOCRINE, THYROID AND DIABETES CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	13262	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	447721027005	OTHER	OK	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	37D0471461	OTHER	OK	CLIA

General Provider Information

NPI Number	:	1609893403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS ENDOCRINE, THYROID AND DIABETES CENTER

Provider Business Mailing Address
First Line	:	PO BOX 268988
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126-8988
Country	:	US
Telephone Number	:	405-843-2066
Fax Number	:	405-843-2077

Provider Business Practice Location Address
First Line	:	6001 NW 120TH CT
Second Line	:	SUITE 6
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-1700
Country	:	US
Telephone Number	:	405-728-7329
Fax Number	:	405-720-2611

Authorized Official
Title or Position	:	OWNER
Name	:	MODHI GUDE
Credential	:	MD
Telephone Number	:	405-728-7329

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	09/16/2015

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Directions to “ACCESS ENDOCRINE, THYROID AND DIABETES CENTER ” Practice Location

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