Provider Demographics
NPI:1932328473
Name:ROSSAVIK, CLAUDIA L (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAUDIA
Middle Name:L
Last Name:ROSSAVIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CLAUDIA
Other - Middle Name:LAGOS
Other - Last Name:ROSSAVIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8009 LAKEHURST DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-4325
Mailing Address - Country:US
Mailing Address - Phone:405-842-2941
Mailing Address - Fax:405-842-7920
Practice Address - Street 1:8009 LAKEHURST DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-4325
Practice Address - Country:US
Practice Address - Phone:405-842-2941
Practice Address - Fax:405-842-7920
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17170261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care