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General NPI Number Information
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NPI Number | 1043250863
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Entity Type | Individual
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Provider Name | RAKESH SHRIVASTAVA MD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 02/16/2022
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Provider Practice Location Address
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Address Line | 105 S BRYANT AVE STE 101
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City | EDMOND
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State | OK
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Zip | 73034-6330
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Country | US
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Telephone | 405-861-0004
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Fax | 855-680-8890
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Provider Business Mailing Address
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Address Line | PO BOX 8350
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City | EDMOND
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State | OK
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Zip | 73083-8350
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Country | US
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Telephone | 405-861-0004
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Fax | 855-680-8890
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 27981
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 27981
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License Number State | OK
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