Provider Demographics
NPI:1588858914
Name:NAMBIAR, SUDHEER V (MD)
Entity Type:Individual
Prefix:DR
First Name:SUDHEER
Middle Name:V
Last Name:NAMBIAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10109 E. 79TH STREET
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133
Mailing Address - Country:US
Mailing Address - Phone:918-286-5000
Mailing Address - Fax:918-249-7514
Practice Address - Street 1:10109 E. 79TH STREET
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133
Practice Address - Country:US
Practice Address - Phone:918-286-5000
Practice Address - Fax:918-249-7514
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK33175207RP1001X, 207RC0200X
CT048196207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ121859TM8Medicare PIN
KYK015110Medicare PIN
KY7100178490Medicaid
NJ121859TM8Medicare PIN
NJP00613665OtherMEDICARE RAILROAD CARRIER
KYK015110Medicare PIN