Provider Demographics
NPI:1154394823
Name:KHETPAL, VIVEK (MD)
Entity type:Individual
Prefix:DR
First Name:VIVEK
Middle Name:
Last Name:KHETPAL
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 1:2701 W. UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2997
Mailing Address - Country:US
Mailing Address - Phone:580-931-0500
Mailing Address - Fax:580-920-8027
Practice Address - Street 1:2701 W. UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2997
Practice Address - Country:US
Practice Address - Phone:580-931-0500
Practice Address - Fax:580-920-8027
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5131207R00000X
OK20426207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK110159828OtherMDC RR
OK100225820AMedicaid