MEDICARE: MARA VASCULAR & INTERVENTIONAL RADIOLOGY OF OKC LLC

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	2085R0204X	Vascular & Interventional Radiology Physician

General Provider Information

NPI Number	:	1295316107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARA VASCULAR & INTERVENTIONAL RADIOLOGY OF OKC LLC

Provider Business Mailing Address
First Line	:	10300 GREENBRIAR PKWY STE B
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7671
Country	:	US
Telephone Number	:	405-669-3569
Fax Number	:

Provider Business Practice Location Address
First Line	:	10300 GREENBRIAR PKWY STE A
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7671
Country	:	US
Telephone Number	:	405-669-3569
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SENTHIL C PALANIAPPUN
Credential	:	MD
Telephone Number	:	408-829-9013

Provider Enumeration Date	:	04/21/2021
Last Update Date	:	08/27/2025

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