Healthcare Provider Details

I. General information

NPI: 1346272523
Provider Name (Legal Business Name): MODHI GUDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 NW 120TH COURT STE 6
OKLAHOMA CITY OK
73162
US

IV. Provider business mailing address

6001 NW 120TH COURT STE 6
OKLAHOMA CITY OK
73162
US

V. Phone/Fax

Practice location:
  • Phone: 405-728-7329
  • Fax: 405-720-2611
Mailing address:
  • Phone: 405-728-7329
  • Fax: 405-720-2611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number13262
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: