Provider Demographics
NPI:1518218304
Name:TIPU, ALI
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:TIPU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6205 N SANTA FE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-7536
Mailing Address - Country:US
Mailing Address - Phone:405-231-8740
Mailing Address - Fax:405-231-8714
Practice Address - Street 1:6205 N SANTA FE AVE STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-7536
Practice Address - Country:US
Practice Address - Phone:405-231-8740
Practice Address - Fax:405-231-8714
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29797207R00000X, 208M00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist