Healthcare Provider Details

I. General information

NPI: 1598309346
Provider Name (Legal Business Name): LATHA NACHIMUTHU MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 W I 240 SERVICE RD STE F
OKLAHOMA CITY OK
73139-2171
US

IV. Provider business mailing address

1145 W I 240 SERVICE RD STE F
OKLAHOMA CITY OK
73139-2171
US

V. Phone/Fax

Practice location:
  • Phone: 405-364-3040
  • Fax:
Mailing address:
  • Phone: 405-364-3040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: LATHA NACHIMUTHU
Title or Position: PROVIDER
Credential: MD
Phone: 703-390-0491