Healthcare Provider Details

I. General information

NPI: 1588858914
Provider Name (Legal Business Name): SUDHEER V NAMBIAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10109 E. 79TH STREET
TULSA OK
74133
US

IV. Provider business mailing address

10109 E. 79TH STREET
TULSA OK
74133
US

V. Phone/Fax

Practice location:
  • Phone: 918-286-5000
  • Fax: 918-249-7514
Mailing address:
  • Phone: 918-286-5000
  • Fax: 918-249-7514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberQ1688
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberQ1688
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number33175
License Number StateOK
# 4
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number33175
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: