Healthcare Provider Details

I. General information

NPI: 1295118065
Provider Name (Legal Business Name): RAHUL HARIDAS RAHANGDALE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S WHEELING AVE STE 701
TULSA OK
74104-5647
US

IV. Provider business mailing address

2000 S WHEELING AVE STE 701
TULSA OK
74104-5647
US

V. Phone/Fax

Practice location:
  • Phone: 918-748-7810
  • Fax: 918-403-6437
Mailing address:
  • Phone: 918-748-7810
  • Fax: 918-403-6437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number35564
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: