Healthcare Provider Details

I. General information

NPI: 1215938691
Provider Name (Legal Business Name): VADAKEPAT RAMGOPAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 NW 56TH ST SUITE 220
OKLAHOMA CITY OK
73112-4479
US

IV. Provider business mailing address

5300 N INDEPENDENCE AVE SUITE 280
OKLAHOMA CITY OK
73112-5556
US

V. Phone/Fax

Practice location:
  • Phone: 405-713-7422
  • Fax: 405-713-7436
Mailing address:
  • Phone: 405-713-7422
  • Fax: 405-713-7436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number11191
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: