Healthcare Provider Details

I. General information

NPI: 1457393894
Provider Name (Legal Business Name): KIRAN PRABHU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 W MEMORIAL RD
OKLAHOMA CITY OK
73142-2015
US

IV. Provider business mailing address

PO BOX 248856
OKLAHOMA CITY OK
73124-8856
US

V. Phone/Fax

Practice location:
  • Phone: 405-369-7819
  • Fax:
Mailing address:
  • Phone: 405-607-4520
  • Fax: 405-896-9870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number16531
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: