Healthcare Provider Details

I. General information

NPI: 1992741094
Provider Name (Legal Business Name): GAURI S WAINGANKAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 W I 240 SERVICE RD SUITE F100
OKLAHOMA CITY OK
73139-2171
US

IV. Provider business mailing address

PO BOX 268988
OKLAHOMA CITY OK
73126-8988
US

V. Phone/Fax

Practice location:
  • Phone: 405-605-6141
  • Fax: 405-605-6244
Mailing address:
  • Phone: 405-605-6141
  • Fax: 405-605-6244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number13381
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number13381
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: