Provider Demographics
NPI:1871789941
Name:GUMMAN, AMITABH (BAMS, ND, PHD, MPH)
Entity type:Individual
Prefix:DR
First Name:AMITABH
Middle Name:
Last Name:GUMMAN
Suffix:
Gender:M
Credentials:BAMS, ND, PHD, MPH
Other - Prefix:DR
Other - First Name:AMIT
Other - Middle Name:
Other - Last Name:GUMMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BAMS, ND, PHD, MPH
Mailing Address - Street 1:3535 NW 58TH ST
Mailing Address - Street 2:SUITE # 750
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4804
Mailing Address - Country:US
Mailing Address - Phone:405-947-4325
Mailing Address - Fax:
Practice Address - Street 1:3535 NW 58TH ST
Practice Address - Street 2:SUITE # 750
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4804
Practice Address - Country:US
Practice Address - Phone:405-947-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
NCCAOM # 006197171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
006197OtherNCCAOM