MEDICARE: MODHI GUDE 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	13262	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	37D0471461	OTHER		CLIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346272523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MODHI GUDE MD

Provider Business Mailing Address
First Line	:	6001 NW 120TH COURT
Second Line	:	STE 6
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162
Country	:	US
Telephone Number	:	405-728-7329
Fax Number	:	405-720-2611

Provider Business Practice Location Address
First Line	:	6001 NW 120TH COURT
Second Line	:	STE 6
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162
Country	:	US
Telephone Number	:	405-728-7329
Fax Number	:	405-720-2611

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	09/08/2015

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