Provider Demographics
NPI:1265813513
Name:AYANAMBAKKAM ATTANATHI, ADANMA ANJI
Entity type:Individual
Prefix:
First Name:ADANMA ANJI
Middle Name:
Last Name:AYANAMBAKKAM ATTANATHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ADANMA ANJI
Other - Middle Name:
Other - Last Name:AYANAMBAKKAM ATTANATHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:215 NE 28TH ST
Mailing Address - Street 2:# 3413
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-2840
Mailing Address - Country:US
Mailing Address - Phone:405-657-7885
Mailing Address - Fax:
Practice Address - Street 1:920 STANTON L YOUNG BLVD
Practice Address - Street 2:WP 1130
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5036
Practice Address - Country:US
Practice Address - Phone:405-271-5963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK390200000207R00000X
OK31486207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine