Provider Demographics
NPI:1932464765
Name:SHAH, GARGI (MD)
Entity Type:Individual
Prefix:
First Name:GARGI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-470-7100
Mailing Address - Fax:405-470-7111
Practice Address - Street 1:5720 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-2010
Practice Address - Country:US
Practice Address - Phone:405-470-7100
Practice Address - Fax:405-470-7111
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125.060878207R00000X
OK31619207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine