| Amal Chakraburtty Inc | |
|
1117 Nw 50th St Oklahoma City OK 73118-4401 | |
| (405) 245-7095 | |
| (405) 722-3900 |
| Full Name | Amal Chakraburtty Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1117 Nw 50th St, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Amal Chakraburtty (PRESIDENT) |
| Authorized Official Contact | 4052457095 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Amal Chakraburtty Inc 8016 Nw 124th St Oklahoma City OK 73142-2233 Ph: (405) 245-7095 | Amal Chakraburtty Inc 1117 Nw 50th St Oklahoma City OK 73118-4401 Ph: (405) 245-7095 |
| NPI Number | 1730695677 |
|---|---|
| Provider Enumeration Date | 12/14/2017 |
| Last Update Date | 12/14/2017 |
| Medicare PECOS PAC ID | 5294090379 |
|---|---|
| Medicare Enrollment ID | O20180518001525 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730695677 | NPI | - | NPPES |
| 1053341362 | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 18371 (Oklahoma) | Primary |
| Provider Name | Amal Chakraburtty |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053341362 PECOS PAC ID: 0840386876 Enrollment ID: I20071022000487 |
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