Provider Demographics
NPI:1518133842
Name:BELUR, REVATHI CHIKKAPPAIAH (MD)
Entity Type:Individual
Prefix:DR
First Name:REVATHI
Middle Name:CHIKKAPPAIAH
Last Name:BELUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REVATHI
Other - Middle Name:
Other - Last Name:CHIKKAPPAIAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 E CLARK BASS BLVD
Mailing Address - Street 2:203
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4269
Mailing Address - Country:US
Mailing Address - Phone:918-423-8200
Mailing Address - Fax:918-423-8222
Practice Address - Street 1:4 E CLARK BASS BLVD
Practice Address - Street 2:203
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4269
Practice Address - Country:US
Practice Address - Phone:918-423-8200
Practice Address - Fax:918-423-8222
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.126930207R00000X
TXU1237207R00000X, 208M00000X
OK30124207RN0300X
IL036126930208M00000X
MO2017036467208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214881Medicare Oscar/Certification