Healthcare Provider Details

I. General information

NPI: 1053341362
Provider Name (Legal Business Name): AMAL CHAKRABURTTY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 N BROOKLINE AVE 900
OKLAHOMA CITY OK
73112-3623
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 405-604-3170
  • Fax: 405-948-2745
Mailing address:
  • Phone: 405-604-3170
  • Fax: 405-948-2745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number18371
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: