Healthcare Provider Details

I. General information

NPI: 1396937082
Provider Name (Legal Business Name): ELITE MEDICAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 09/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3336 E. 32ND STREET SUITE 200
TULSA OK
74135-4442
US

IV. Provider business mailing address

3336 E. 32ND STREET SUITE 200
TULSA OK
74135-4442
US

V. Phone/Fax

Practice location:
  • Phone: 918-742-4900
  • Fax: 918-742-4901
Mailing address:
  • Phone: 918-742-4900
  • Fax: 918-742-4901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23724
License Number StateOK

VIII. Authorized Official

Name: DR. VISHAL AGGARWAL
Title or Position: MEMBER
Credential: MD
Phone: 918-742-4900