Healthcare Provider Details

I. General information

NPI: 1881219384
Provider Name (Legal Business Name): PANKHURI BANERJEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date: 08/04/2022
Reactivation Date: 09/21/2022

III. Provider practice location address

4444 E 41ST ST
TULSA OK
74135-2527
US

IV. Provider business mailing address

4444 E 41ST ST
TULSA OK
74135-2527
US

V. Phone/Fax

Practice location:
  • Phone: 918-619-4400
  • Fax: 918-619-4152
Mailing address:
  • Phone: 918-619-4400
  • Fax: 918-619-4152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberBP10072590
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number50004
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: