Provider Demographics
NPI:1871581488
Name:SHETTY, SATHEESH KUMAR (MD)
Entity type:Individual
Prefix:
First Name:SATHEESH
Middle Name:KUMAR
Last Name:SHETTY
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:PO BOX 21891
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73156-1891
Mailing Address - Country:US
Mailing Address - Phone:405-834-4274
Mailing Address - Fax:405-748-4694
Practice Address - Street 1:3048 SW 89TH ST
Practice Address - Street 2:STE- A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6385
Practice Address - Country:US
Practice Address - Phone:405-834-4274
Practice Address - Fax:405-748-4694
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18820207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100183140AMedicaid
OK175507600OtherDEPT OF LABOR
OK5043442OtherAETNA
OKG38137Medicare UPIN
OKOK700217Medicare PIN