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General NPI Number Information
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NPI Number | 1184034134
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Entity Type | Individual
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Provider Name | PRADYUMNA AGASTHI M.B.B.S
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Gender | Male
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Dates
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Enumeration Date | 04/30/2014
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 341 S 33RD ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-5037
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Country | US
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Telephone | 918-683-1831
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Fax | 918-687-7043
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Provider Business Mailing Address
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Address Line | 6600 S YALE AVE STE 1200
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City | TULSA
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State | OK
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Zip | 74136-3361
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Country | US
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Telephone |
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Fax |
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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 | 207RA0002X
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Taxonomy Name | Adult Congenital Heart Disease Physician
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License Number | 44552
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 44552
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 20044
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License Number State | ND
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