Basic Information
| Provider Information | |||||||||
| NPI: | 1366602617 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KODE | ||||||||
| FirstName: | RAVI | ||||||||
| MiddleName: | KIRAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1923 S UTICA AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741046520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187487680 | ||||||||
| FaxNumber: | 9184036341 | ||||||||
| Practice Location | |||||||||
| Address1: | 1923 S UTICA AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741046520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187487650 | ||||||||
| FaxNumber: | 9184036341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2008 | ||||||||
| LastUpdateDate: | 03/08/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD.203831 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 29987 | OK | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.