Healthcare Provider Details

I. General information

NPI: 1295043883
Provider Name (Legal Business Name): MUKTA DILIPKUMAR AGRAWAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 NE 13TH ST # 3G3210
OKLAHOMA CITY OK
73104-5008
US

IV. Provider business mailing address

940 NE 13TH ST # 3G3210
OKLAHOMA CITY OK
73104-5008
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5125
  • Fax: 405-271-3462
Mailing address:
  • Phone: 405-271-5125
  • Fax: 405-271-3462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number33753
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: