Provider Demographics
NPI:1346272523
Name:GUDE, MODHI (MD)
Entity Type:Individual
Prefix:
First Name:MODHI
Middle Name:
Last Name:GUDE
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 1:6001 NW 120TH COURT
Mailing Address - Street 2:STE 6
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162
Mailing Address - Country:US
Mailing Address - Phone:405-728-7329
Mailing Address - Fax:405-720-2611
Practice Address - Street 1:6001 NW 120TH COURT
Practice Address - Street 2:STE 6
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162
Practice Address - Country:US
Practice Address - Phone:405-728-7329
Practice Address - Fax:405-720-2611
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13262207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
37D0471461OtherCLIA
OK100131440AMedicaid
37D0471461OtherCLIA
OK100131440AMedicaid