Basic Information
| Provider Information | |||||||||
| NPI: | 1235246018 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NACHIMUTHU | ||||||||
| FirstName: | SENTHIL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 802738 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641802738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055333010 | ||||||||
| FaxNumber: | 4055335314 | ||||||||
| Practice Location | |||||||||
| Address1: | 1323 W 6TH AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | STILLWATER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740744306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055333010 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 06/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD14431R | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 27598 | OK | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 27598 | OK | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RC0001X | 27598 | OK | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
No ID Information.