Healthcare Provider Details

I. General information

NPI: 1508399437
Provider Name (Legal Business Name): SOWGANDHI NANNEPAGA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10109 E 79TH ST
TULSA OK
74133-4564
US

IV. Provider business mailing address

6120 S YALE AVE STE 1210
TULSA OK
74136-4241
US

V. Phone/Fax

Practice location:
  • Phone: 918-233-9550
  • Fax: 918-752-0204
Mailing address:
  • Phone: 918-888-5211
  • Fax: 918-888-5270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number47140
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: