Provider Demographics
NPI:1063767861
Name:MADA, PRADEEP KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:PRADEEP KUMAR
Middle Name:
Last Name:MADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 W GORE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6350
Mailing Address - Country:US
Mailing Address - Phone:580-250-6555
Mailing Address - Fax:
Practice Address - Street 1:3201 W GORE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6350
Practice Address - Country:US
Practice Address - Phone:580-250-6555
Practice Address - Fax:580-354-5942
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK35514207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease