Healthcare Provider Details

I. General information

NPI: 1174738413
Provider Name (Legal Business Name): KAVITA K SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6126 E 61ST ST
TULSA OK
74136-2117
US

IV. Provider business mailing address

5310 E 31ST ST STE 13
TULSA OK
74135-5013
US

V. Phone/Fax

Practice location:
  • Phone: 918-576-6998
  • Fax: 918-584-8620
Mailing address:
  • Phone: 918-561-5701
  • Fax: 918-561-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number28092
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207QB0505X
TaxonomyDiabetology (Internal Medicine) Physician
License Number28092
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberDR.0071548
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number28092
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number77175
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP7348
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: