Healthcare Provider Details

I. General information

NPI: 1558744037
Provider Name (Legal Business Name): RAVI D PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 NW EXPRESSWAY
OKLAHOMA CITY OK
73112-4999
US

IV. Provider business mailing address

300 SW 167TH ST
OKLAHOMA CITY OK
73170-6708
US

V. Phone/Fax

Practice location:
  • Phone: 405-949-3011
  • Fax:
Mailing address:
  • Phone: 216-246-6160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number34000
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: