Healthcare Provider Details

I. General information

NPI: 1225523707
Provider Name (Legal Business Name): RAHUL MYADAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6151 S YALE AVE STE 100A
TULSA OK
74136-1929
US

IV. Provider business mailing address

6600 S YALE AVE STE 1200
TULSA OK
74136-3361
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-8500
  • Fax: 918-307-5578
Mailing address:
  • Phone: 918-499-4855
  • Fax: 918-488-6098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number47391
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: