Healthcare Provider Details

I. General information

NPI: 1578836201
Provider Name (Legal Business Name): GAJALAKSHMI KUMAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S WHEELING AVE STE 606
TULSA OK
74104-5638
US

IV. Provider business mailing address

1919 S WHEELING AVE STE 606
TULSA OK
74104-5638
US

V. Phone/Fax

Practice location:
  • Phone: 918-301-2505
  • Fax: 918-744-3633
Mailing address:
  • Phone: 918-301-2505
  • Fax: 918-744-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number30604
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number30604
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: