Provider Demographics
NPI:1780747261
Name:AJMERA, HARESH KANTILAL (MD)
Entity type:Individual
Prefix:DR
First Name:HARESH
Middle Name:KANTILAL
Last Name:AJMERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 S UTICA AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4014
Mailing Address - Country:US
Mailing Address - Phone:918-744-8115
Mailing Address - Fax:918-744-8117
Practice Address - Street 1:1145 S UTICA AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4014
Practice Address - Country:US
Practice Address - Phone:918-744-8115
Practice Address - Fax:918-744-8117
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10644207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100008620AMedicaid
OK$$$$$$$$$Medicare PIN
C94622Medicare UPIN
73-1045313OtherOTHER INS. PROVIDER ID