Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 36301 | OK |
Y | 111NI0900X | Internist | 36301 | OK |
N | 207RR0500X | Rheumatology | 10324 | ND |
N | 207RR0500X | Rheumatology | 277958 | NY |
NPI | 1073615324 |
---|---|
Provider Name | Prashant Kaushik |
First Address | Tahlequah, OK 74464-3365 |
Second Address | Tahlequah, OK 74464-3365 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 15/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10324 | LICENSE (01) | ND |
14044 | (05) | ND |
H66020 | (02) | |
P00341234 | RAILROAD MEDICARE (01) | ND |