Healthcare Provider Details

I. General information

NPI: 1467527044
Provider Name (Legal Business Name): KUMAR B ENNAMURI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 N PORTER AVE STE 300
NORMAN OK
73071-6443
US

IV. Provider business mailing address

1125 N PORTER AVE STE 300
NORMAN OK
73071-6443
US

V. Phone/Fax

Practice location:
  • Phone: 405-364-0630
  • Fax: 405-364-0760
Mailing address:
  • Phone: 405-364-0630
  • Fax: 405-364-0760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KUMAR B. ENNAMURI
Title or Position: OWNER
Credential: M.D.
Phone: 405-364-0630