Provider Demographics
NPI:1891211215
Name:VADIVELU, KOUSIGAN CHETIPATI (MD, MSC)
Entity Type:Individual
Prefix:
First Name:KOUSIGAN
Middle Name:CHETIPATI
Last Name:VADIVELU
Suffix:
Gender:M
Credentials:MD, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 EVERETT DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5047
Mailing Address - Country:US
Mailing Address - Phone:405-271-5125
Mailing Address - Fax:
Practice Address - Street 1:1200 EVERETT DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-271-5125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program