Healthcare Provider Details

I. General information

NPI: 1700197670
Provider Name (Legal Business Name): ROHINI CHENNURI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 W. WILLOW ROAD STE C
ENID OK
73703
US

IV. Provider business mailing address

1204 W. WILLOW ROAD STE C
ENID OK
73703
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-2273
  • Fax:
Mailing address:
  • Phone: 866-600-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number036-133272
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number31925
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: