Healthcare Provider Details

I. General information

NPI: 1376563163
Provider Name (Legal Business Name): SEETHAL R MADHAVARAPU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13401 N WESTERN AVE. STE. 301
OKLAHOMA CITY OK
73114
US

IV. Provider business mailing address

3400 W TECUMSEH RD STE 101
NORMAN OK
73072-1810
US

V. Phone/Fax

Practice location:
  • Phone: 405-478-7111
  • Fax: 405-360-6769
Mailing address:
  • Phone: 405-360-6764
  • Fax: 405-360-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number23053
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number23053
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: