Healthcare Provider Details

I. General information

NPI: 1295701738
Provider Name (Legal Business Name): ATULKUMAR DAVE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 PAYSPHERE CIR
CHICAGO IL
60674-0023
US

IV. Provider business mailing address

10109 E 79TH ST
TULSA OK
74133-4564
US

V. Phone/Fax

Practice location:
  • Phone: 847-746-4358
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number21163
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: