Provider Demographics
NPI:1659308435
Name:KANAGALA, RAJESH (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:
Last Name:KANAGALA
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 1:4205 MCAULEY BLVD STE 375
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-9309
Mailing Address - Country:US
Mailing Address - Phone:405-749-4247
Mailing Address - Fax:405-749-4249
Practice Address - Street 1:4205 MCAULEY BLVD STE 375
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9309
Practice Address - Country:US
Practice Address - Phone:405-749-4247
Practice Address - Fax:405-749-4249
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26001207RT0003X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34868300Medicaid
OK200126240AMedicaid
WI34868300Medicaid
OKP00917835Medicare PIN
OK200126240AMedicaid