Individual
DR. ASHTAMI VISHWANATH BANAVALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
430 N MONTE VISTA ST, ADA, OK 74820-4610
(580) 421-1141
(580) 421-1224
Mailing address
430 N MONTE VISTA ST, ADA, OK 74820-4610
(580) 421-1141
(580) 421-1224
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
P26486
MD
207RH0003X
Hematology & Oncology Physician
Primary
32636
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
NY
Other
Enumeration date
07/31/2011
Last updated
12/29/2017
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