Provider Demographics
NPI:1578836201
Name:KUMAR, GAJAL (MD)
Entity Type:Individual
Prefix:
First Name:GAJAL
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1919 S WHEELING AVE
Mailing Address - Street 2:STE 606
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5638
Mailing Address - Country:US
Mailing Address - Phone:918-301-2505
Mailing Address - Fax:918-744-3633
Practice Address - Street 1:1919 S WHEELING AVE
Practice Address - Street 2:STE 606
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5638
Practice Address - Country:US
Practice Address - Phone:918-301-2505
Practice Address - Fax:918-744-3633
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK30604208600000X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery