Healthcare Provider Details

I. General information

NPI: 1295752160
Provider Name (Legal Business Name): PRAVEEN K PONNAMREDDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NE 10TH ST # 2E
OKLAHOMA CITY OK
73104-5417
US

IV. Provider business mailing address

825 NE 10TH ST # 2E
OKLAHOMA CITY OK
73104-5417
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-7001
  • Fax: 405-271-7034
Mailing address:
  • Phone: 405-271-7001
  • Fax: 405-271-7034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number229636
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number45006
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207RH0005X
TaxonomyHypertension Specialist Physician
License Number229636
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number229636
License Number StateMA
# 5
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number45006
License Number StateOK
# 6
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number16872
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: