Provider Demographics
NPI:1578580205
Name:VASAN, NILESH R (MD)
Entity Type:Individual
Prefix:DR
First Name:NILESH
Middle Name:R
Last Name:VASAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 26901
Mailing Address - Street 2:WP 1290
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-0901
Mailing Address - Country:US
Mailing Address - Phone:405-271-8001
Mailing Address - Fax:405-271-3248
Practice Address - Street 1:920 STANTON L YOUNG BLVD
Practice Address - Street 2:WP 1290
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5036
Practice Address - Country:US
Practice Address - Phone:405-271-8001
Practice Address - Fax:405-271-3248
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-03-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT042319207Y00000X
OK23030207Y00000X, 207YX0007X, 207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology