Healthcare Provider Details

I. General information

NPI: 1649274374
Provider Name (Legal Business Name): KIRTIDA GURJAR KUMAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 NW 56TH ST STE 800
OKLAHOMA CITY OK
73112-4452
US

IV. Provider business mailing address

3433 NW 56TH ST STE 400
OKLAHOMA CITY OK
73112-4430
US

V. Phone/Fax

Practice location:
  • Phone: 405-946-9831
  • Fax:
Mailing address:
  • Phone: 405-948-9831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number17510
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: