Provider Demographics
NPI:1659954451
Name:MUDGAPALLI, VIKAS VENKATA (DO)
Entity Type:Individual
Prefix:
First Name:VIKAS
Middle Name:VENKATA
Last Name:MUDGAPALLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 SOUTHWEST BLVD
Mailing Address - Street 2:OSU HEALTH CARE CENTER
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107
Mailing Address - Country:US
Mailing Address - Phone:918-582-1980
Mailing Address - Fax:918-561-1289
Practice Address - Street 1:2345 SOUTHWEST BLVD
Practice Address - Street 2:OSU HEALTH CARE CENTER
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74107
Practice Address - Country:US
Practice Address - Phone:918-582-1980
Practice Address - Fax:918-561-1289
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEH13538337OtherDRIVER'S LICENSE ID