Individual
RAKESH SHRIVASTAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
105 S BRYANT AVE STE 101, EDMOND, OK 73034-6330
(405) 861-0004
(855) 680-8890
Mailing address
PO BOX 8350, EDMOND, OK 73083-8350
(405) 861-0004
(855) 680-8890
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
27981
OK
207RI0011X
Interventional Cardiology Physician
27981
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000924679001
HEALTHNOW
—
01
—
107177BJ
PREFERRED CARE MCO
—
01
—
9704619
GHI
—
01
—
MDG288
PREFERRED CARE MCO
—
01
—
P010001487
BLUE CHOICE MCO
—
Enumeration date
06/08/2006
Last updated
02/16/2022
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