Provider Demographics
NPI:1366939563
Name:VEDALA, KRISHNA (MD)
Entity type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:
Last Name:VEDALA
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 1:2605 SW 119TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-2601
Mailing Address - Country:US
Mailing Address - Phone:405-912-3400
Mailing Address - Fax:405-912-3445
Practice Address - Street 1:2605 SW 119TH ST STE A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-2601
Practice Address - Country:US
Practice Address - Phone:405-912-3400
Practice Address - Fax:405-912-3445
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK38348207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine