MEDICARE: VIJAY K KOLLI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	28955	OK

General Provider Information

NPI Number	:	1013017292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIJAY K KOLLI MD

Provider Business Mailing Address
First Line	:	1104E STATE HIGHWAY 152
Second Line	:
City	:	MUSTANG
State	:	OK
Zip	:	73064-5116
Country	:	US
Telephone Number	:	855-541-2862
Fax Number	:	405-716-4808

Provider Business Practice Location Address
First Line	:	1111 N LEE AVE STE 249
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-2600
Country	:	US
Telephone Number	:	405-594-5848
Fax Number	:	54-594-5847

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	01/16/2025

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