Healthcare Provider Details

I. General information

NPI: 1609893403
Provider Name (Legal Business Name): ACCESS ENDOCRINE, THYROID AND DIABETES CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 NW 120TH CT SUITE 6
OKLAHOMA CITY OK
73162-1700
US

IV. Provider business mailing address

PO BOX 268988
OKLAHOMA CITY OK
73126-8988
US

V. Phone/Fax

Practice location:
  • Phone: 405-728-7329
  • Fax: 405-720-2611
Mailing address:
  • Phone: 405-843-2066
  • Fax: 405-843-2077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number13262
License Number StateOK

VIII. Authorized Official

Name: MODHI GUDE
Title or Position: OWNER
Credential: MD
Phone: 405-728-7329