1851300438 NPI number — DR. WILLIAM RANDALL KAKISH M.D.

Table of content: DR. WILLIAM RANDALL KAKISH M.D. (NPI 1851300438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851300438 NPI number — DR. WILLIAM RANDALL KAKISH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAKISH
Provider First Name:
WILLIAM
Provider Middle Name:
RANDALL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851300438
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4200 W MEMORIAL RD
Provider Second Line Business Mailing Address:
901
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73120-9350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-749-4247
Provider Business Mailing Address Fax Number:
405-749-4249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4200 W MEMORIAL RD
Provider Second Line Business Practice Location Address:
901
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73120-9350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-749-4247
Provider Business Practice Location Address Fax Number:
405-749-4249
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  17088 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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