Healthcare Provider Details

I. General information

NPI: 1447754007
Provider Name (Legal Business Name): RAJARAM MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S BRYANT AVE
EDMOND OK
73034
US

IV. Provider business mailing address

15312 KESTRAL LAKE DR
EDMOND OK
73013-9695
US

V. Phone/Fax

Practice location:
  • Phone: 405-622-3063
  • Fax: 405-732-0022
Mailing address:
  • Phone: 405-637-9438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number28679
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VENKATARAMAN RAJARAM
Title or Position: OWNER
Credential: MD
Phone: 405-622-3063