Provider Demographics
NPI:1780688705
Name:PRABHU, SANTOSH THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:SANTOSH
Middle Name:THOMAS
Last Name:PRABHU
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 1:3433 NW 56TH ST
Mailing Address - Street 2:STE 400
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4430
Mailing Address - Country:US
Mailing Address - Phone:405-947-3341
Mailing Address - Fax:
Practice Address - Street 1:3433 NW 56TH ST
Practice Address - Street 2:STE 400
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4430
Practice Address - Country:US
Practice Address - Phone:405-947-3341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14169207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease