Provider Demographics
NPI:1447796545
Name:HARESH K AJMERA MD INC
Entity Type:Organization
Organization Name:HARESH K AJMERA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BHARATI
Authorized Official - Middle Name:H
Authorized Official - Last Name:AJMERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-744-8115
Mailing Address - Street 1:1145 S UTICA AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4014
Mailing Address - Country:US
Mailing Address - Phone:918-744-8115
Mailing Address - Fax:918-744-8117
Practice Address - Street 1:1145 S UTICA AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4014
Practice Address - Country:US
Practice Address - Phone:918-744-8115
Practice Address - Fax:918-744-8117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10644174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100732990AMedicaid
OK100732990AMedicaid