Healthcare Provider Details

I. General information

NPI: 1952680084
Provider Name (Legal Business Name): KRITTAPOOM AKRAWINTHAWONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2011
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
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

1122 NE 13TH ST # 262
OKLAHOMA CITY OK
73117-1039
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-8478
  • Fax: 405-271-4230
Mailing address:
  • Phone: 405-271-4742
  • Fax: 405-271-2619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301098268
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036.147424
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number036.147424
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number39775
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: