Provider Demographics
NPI:1073582961
Name:RAGHURAMAN, VASUEVAN UNNITHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:VASUEVAN
Middle Name:UNNITHAN
Last Name:RAGHURAMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6600 S YALE AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3361
Mailing Address - Country:US
Mailing Address - Phone:918-488-6045
Mailing Address - Fax:918-488-6098
Practice Address - Street 1:6160 S YALE AVE FL 1
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1930
Practice Address - Country:US
Practice Address - Phone:918-497-3300
Practice Address - Fax:918-497-3365
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37588207RG0100X
OK25011207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200090470AMedicaid
104786222OtherCAQH
104786222OtherCAQH
OK245631401Medicare PIN