=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437727922
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROOPESH SAI JAKULLA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2021
-----------------------------------------------------
Last Update Date | 09/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 STANTON L YOUNG BLVD # 5400
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73104-5018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-271-4742
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2301 HOLMES STREET TRUMAN MEDICAL CENTER -HOSPITAL HILL
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 64108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-404-4175
-----------------------------------------------------
Fax | 816-404-0003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 42835
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------