Healthcare Provider Details

I. General information

NPI: 1407239072
Provider Name (Legal Business Name): AMIT M MISTRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 N E 13TH ST
OKLAHOMA CITY OK
73104
US

IV. Provider business mailing address

921 N E 13TH ST
OKLAHOMA CITY OK
73104
US

V. Phone/Fax

Practice location:
  • Phone: 405-456-1000
  • Fax:
Mailing address:
  • Phone: 405-456-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number31518
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number31518
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: