Provider Demographics
NPI:1659457703
Name:ANKLESARIA, GAURANGI MANEK (MD)
Entity Type:Individual
Prefix:DR
First Name:GAURANGI
Middle Name:MANEK
Last Name:ANKLESARIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:817 S ELM PL
Mailing Address - Street 2:#104
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-5369
Mailing Address - Country:US
Mailing Address - Phone:918-251-9698
Mailing Address - Fax:918-251-8805
Practice Address - Street 1:817 S ELM PL
Practice Address - Street 2:#104
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-5369
Practice Address - Country:US
Practice Address - Phone:918-251-9698
Practice Address - Fax:918-251-8805
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK13575207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine