Healthcare Provider Details

I. General information

NPI: 1043257413
Provider Name (Legal Business Name): RAVIKUMAR VASIREDDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N. 32ND ST.
MUSKOGEE OK
74401-5037
US

IV. Provider business mailing address

PO BOX 749495
ATLANTA GA
30374-9495
US

V. Phone/Fax

Practice location:
  • Phone: 918-683-2000
  • Fax: 918-686-0554
Mailing address:
  • Phone: 855-963-2100
  • Fax: 813-321-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number21102
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number21102
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: