Healthcare Provider Details

I. General information

NPI: 1174593461
Provider Name (Legal Business Name): RAJESH H CHANDWANEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 S UTICA AVE SUITE 300
TULSA OK
74104-4243
US

IV. Provider business mailing address

9228 S MINGO RD SUITE 200
TULSA OK
74133-5718
US

V. Phone/Fax

Practice location:
  • Phone: 918-592-0999
  • Fax: 918-592-1021
Mailing address:
  • Phone: 918-592-0999
  • Fax: 918-878-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number23320
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number23320
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: