Healthcare Provider Details

I. General information

NPI: 1124160056
Provider Name (Legal Business Name): ANUPA KHASTGIR MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3366 NW EXPRESSWAY ST SUITE 208
OKLAHOMA CITY OK
73112-4462
US

IV. Provider business mailing address

3366 NW EXPRESSWAY ST SUITE 208
OKLAHOMA CITY OK
73112-4462
US

V. Phone/Fax

Practice location:
  • Phone: 405-942-0794
  • Fax: 405-948-0537
Mailing address:
  • Phone: 405-942-0794
  • Fax: 405-948-0537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number18132
License Number StateOK

VIII. Authorized Official

Name: KIMBERLY BAILEY
Title or Position: BILLING MANAGER
Credential:
Phone: 405-373-4340