Healthcare Provider Details

I. General information

NPI: 1023158482
Provider Name (Legal Business Name): ARCHANA GAUTAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 HEALTHPLEX PKWY STE 200
NORMAN OK
73072-9801
US

IV. Provider business mailing address

PO BOX 269031
OKLAHOMA CITY OK
73126-9031
US

V. Phone/Fax

Practice location:
  • Phone: 405-515-2222
  • Fax: 405-307-5617
Mailing address:
  • Phone: 405-310-0836
  • Fax: 405-758-5582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number22150
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number22150
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number22150
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: