Healthcare Provider Details

I. General information

NPI: 1750010278
Provider Name (Legal Business Name): RITVIK BHATTACHARJEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19600 E ROSS ST
TAHLEQUAH OK
74464-0545
US

IV. Provider business mailing address

1209 W LISA ANN DR
TAHLEQUAH OK
74464-5190
US

V. Phone/Fax

Practice location:
  • Phone: 539-234-1000
  • Fax:
Mailing address:
  • Phone: 281-772-1026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9130
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: