Provider Demographics
NPI:1811927833
Name:CHAUDHURI, DEBASISH (MD)
Entity type:Individual
Prefix:DR
First Name:DEBASISH
Middle Name:
Last Name:CHAUDHURI
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 1:6600 S YALE AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3331
Mailing Address - Country:US
Mailing Address - Phone:918-488-6687
Mailing Address - Fax:918-488-6098
Practice Address - Street 1:3340 W OKMULGEE ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5069
Practice Address - Country:US
Practice Address - Phone:918-687-6002
Practice Address - Fax:918-687-6216
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK32245207RC0000X
TXM6079207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX750137OtherMEDICARE
1811927833OtherNPI
OK200593240AMedicaid
TX192439104Medicaid
TX274354YRMTMedicare PIN