Provider Demographics
NPI:1154415347
Name:KURELLA, RAVINDER R (MD)
Entity type:Individual
Prefix:DR
First Name:RAVINDER
Middle Name:R
Last Name:KURELLA
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 1:525 SW 80TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-9502
Mailing Address - Country:US
Mailing Address - Phone:405-631-0481
Mailing Address - Fax:405-631-9025
Practice Address - Street 1:525 SW 80TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9502
Practice Address - Country:US
Practice Address - Phone:405-631-0481
Practice Address - Fax:405-631-9025
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22226207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN