MEDICARE: DR. AVANI SHETH MD

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	208VP0000X	Pain Medicine Physician	14599	OK
2	207L00000X	Anesthesiology Physician	14599	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	050063896	OTHER	OK	MEDICARE RR
4	P00424369	OTHER	OK	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	208041773001	OTHER	OK	BC/BS

General Provider Information

NPI Number	:	1780688150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AVANI SHETH MD

Provider Business Mailing Address
First Line	:	3705 W MEMORIAL RD
Second Line	:	STE 302
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-1506
Country	:	US
Telephone Number	:	405-775-9350
Fax Number	:	405-775-9360

Provider Business Practice Location Address
First Line	:	4200 W MEMORIAL RD
Second Line	:	STE 305
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-9350
Country	:	US
Telephone Number	:	405-841-7899
Fax Number	:	405-749-9779

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/09/2014

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Directions to “ DR. AVANI SHETH MD” Practice Location

Language	Start Address	Practice Location

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