Provider Demographics
NPI:1982304606
Name:TAMAKUWALA, KARAN
Entity Type:Individual
Prefix:
First Name:KARAN
Middle Name:
Last Name:TAMAKUWALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4507 W DETROIT PL
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-8674
Mailing Address - Country:US
Mailing Address - Phone:918-323-5863
Mailing Address - Fax:
Practice Address - Street 1:10801 S WESTERN AVE STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-6222
Practice Address - Country:US
Practice Address - Phone:405-703-8404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program