Provider Demographics
NPI:1467527044
Name:KUMAR ENNAMURI MD PC
Entity Type:Organization
Organization Name:KUMAR ENNAMURI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KUMAR
Authorized Official - Middle Name:B
Authorized Official - Last Name:ENNAMURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-364-0630
Mailing Address - Street 1:1125 N PORTER AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6443
Mailing Address - Country:US
Mailing Address - Phone:405-364-0630
Mailing Address - Fax:405-364-0760
Practice Address - Street 1:1125 N PORTER AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6446
Practice Address - Country:US
Practice Address - Phone:405-364-0630
Practice Address - Fax:405-364-0760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2015-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK700522140Medicare ID - Type Unspecified