Provider Demographics
NPI:1649478447
Name:SUHAS D AGTE MD PC
Entity type:Organization
Organization Name:SUHAS D AGTE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUHAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:AGTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-357-8330
Mailing Address - Street 1:5108 W GORE BLVD
Mailing Address - Street 2:SUITE2
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6025
Mailing Address - Country:US
Mailing Address - Phone:580-357-8330
Mailing Address - Fax:580-357-6080
Practice Address - Street 1:5108 W GORE BLVD
Practice Address - Street 2:SUITE2
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6025
Practice Address - Country:US
Practice Address - Phone:580-357-8330
Practice Address - Fax:580-357-6080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG59208Medicare UPIN