Provider Demographics
NPI:1477847374
Name:MEENAKSHI-SUNDARAM, BHALAAJEE (MD)
Entity Type:Individual
Prefix:
First Name:BHALAAJEE
Middle Name:
Last Name:MEENAKSHI-SUNDARAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:920 STANTON L YOUNG BLVD # WP2140
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5036
Mailing Address - Country:US
Mailing Address - Phone:405-271-6900
Mailing Address - Fax:405-271-3118
Practice Address - Street 1:1200 CHILDRENS AVE # 7D
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-271-3800
Practice Address - Fax:405-271-3801
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK28575208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology