Provider Demographics
NPI:1043257413
Name:VASIREDDY, RAVIKUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVIKUMAR
Middle Name:
Last Name:VASIREDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 678453
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8453
Mailing Address - Country:US
Mailing Address - Phone:918-683-2000
Mailing Address - Fax:918-686-0554
Practice Address - Street 1:301 N. 32ND ST.
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5037
Practice Address - Country:US
Practice Address - Phone:918-683-2000
Practice Address - Fax:918-686-0554
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21102207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100027960AMedicaid
OK100027960AMedicaid
OKOKA102332Medicare Oscar/Certification