Healthcare Provider Details

I. General information

NPI: 1538663745
Provider Name (Legal Business Name): HITESH J PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3261 24TH AVE NW STE 101
NORMAN OK
73069-6666
US

IV. Provider business mailing address

3261 24TH AVE NW STE 101
NORMAN OK
73069-6666
US

V. Phone/Fax

Practice location:
  • Phone: 405-364-6432
  • Fax: 816-525-2697
Mailing address:
  • Phone: 405-364-6432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number94-09700
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number39391
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: