Provider Demographics
NPI:1952132409
Name:RAVISHANKAR KOMARI, ALOK GOVIND
Entity type:Individual
Prefix:DR
First Name:ALOK GOVIND
Middle Name:
Last Name:RAVISHANKAR KOMARI
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ALOK
Other - Middle Name:
Other - Last Name:GOVIND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:920 STANTON L YOUNG BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5036
Mailing Address - Country:US
Mailing Address - Phone:405-271-4113
Mailing Address - Fax:
Practice Address - Street 1:1100 N LINDSAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5410
Practice Address - Country:US
Practice Address - Phone:405-271-4113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK437302084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty