Individual
ANNIE VENUGOPAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1705 E 19TH STREET, SUITE 501, TULSA, OK 74104-5416
(918) 744-8110
(918) 744-8111
Mailing address
1705 E 19TH STREET, SUITE 501, TULSA, OK 74104-5416
(918) 744-8110
(918) 744-8111
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
13326
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100009780A
—
OK
Enumeration date
11/21/2005
Last updated
02/08/2010
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