Healthcare Provider Details

I. General information

NPI: 1558743302
Provider Name (Legal Business Name): SANJANA MULLANGI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2015
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 W 110TH ST
OVERLAND PARK KS
66210-4045
US

IV. Provider business mailing address

1145 S UTICA AVE STE 460
TULSA OK
74104-4041
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-1227
  • Fax:
Mailing address:
  • Phone: 918-579-5749
  • Fax: 918-579-5762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number04-45469
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: