Provider Demographics
NPI:1073615324
Name:KAUSHIK, PRASHANT (MD)
Entity type:Individual
Prefix:
First Name:PRASHANT
Middle Name:
Last Name:KAUSHIK
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 1:1373 E BOONE ST STE 2300
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-3365
Mailing Address - Country:US
Mailing Address - Phone:918-207-0025
Mailing Address - Fax:918-207-0026
Practice Address - Street 1:1373 E BOONE ST STE 2300
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-3365
Practice Address - Country:US
Practice Address - Phone:918-207-0025
Practice Address - Fax:918-207-0026
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND10324207RR0500X
NY277958207RR0500X
OK36301207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND10324OtherLICENSE
ND14044Medicaid
NDP00341234OtherRAILROAD MEDICARE
H66020Medicare UPIN
NDP00341234OtherRAILROAD MEDICARE