Provider Demographics
NPI:1689648958
Name:ANKLESARIA, MANEK EDALJI (MD)
Entity Type:Individual
Prefix:DR
First Name:MANEK
Middle Name:EDALJI
Last Name:ANKLESARIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4815 S HARVARD AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3066
Mailing Address - Country:US
Mailing Address - Phone:918-895-7855
Mailing Address - Fax:918-745-9800
Practice Address - Street 1:4815 S HARVARD AVE STE 210
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3066
Practice Address - Country:US
Practice Address - Phone:918-895-7855
Practice Address - Fax:918-745-9800
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13574207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100249760CMedicaid
C94638Medicare UPIN
248501201Medicare PIN
OK248501201Medicare PIN
OK100249760CMedicaid