Healthcare Provider Details

I. General information

NPI: 1770320038
Provider Name (Legal Business Name): RK VASIREDDY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 32ND ST
MUSKOGEE OK
74401-2106
US

IV. Provider business mailing address

301 N 32ND ST
MUSKOGEE OK
74401-2106
US

V. Phone/Fax

Practice location:
  • Phone: 918-683-2000
  • Fax: 918-686-0554
Mailing address:
  • Phone: 918-683-2000
  • Fax: 918-686-0554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: RAVIKUMAR VASIREDDY
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 918-978-9196