Individual
PAVANKUMAR BOMMASAMUDRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1705 E 19TH ST, STE #302, TULSA, OK 74104-5405
(918) 748-7585
(918) 748-7539
Mailing address
1705 E 19TH ST, STE #302, TULSA, OK 74104
(918) 748-7585
(918) 748-7539
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
04-41542
KS
207R00000X
Internal Medicine Physician
Primary
27309
OK
Other
Enumeration date
06/22/2009
Last updated
12/05/2018
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