Provider Demographics
NPI:1013950740
Name:MOTWANI, RAJENDRA K (DO)
Entity Type:Individual
Prefix:
First Name:RAJENDRA
Middle Name:K
Last Name:MOTWANI
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 1:9817 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2812
Mailing Address - Country:US
Mailing Address - Phone:405-632-4500
Mailing Address - Fax:405-632-7500
Practice Address - Street 1:9817 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2812
Practice Address - Country:US
Practice Address - Phone:405-632-4500
Practice Address - Fax:405-632-7500
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3478208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100167910BMedicaid
OK100167910BMedicaid
OKP00395104Medicare PIN
5390430017Medicare NSC
OK24C707501Medicare PIN
OK243408401Medicare PIN
F56206Medicare UPIN