Healthcare Provider Details

I. General information

NPI: 1003987611
Provider Name (Legal Business Name): ASHOK KRISHNAMURTHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6718 S WESTERN AVE
OKLAHOMA CITY OK
73139-1807
US

IV. Provider business mailing address

6718 S WESTERN AVE
OKLAHOMA CITY OK
73139-1807
US

V. Phone/Fax

Practice location:
  • Phone: 405-602-1053
  • Fax: 405-602-1059
Mailing address:
  • Phone: 405-602-1053
  • Fax: 405-602-1059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number24186
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: