Basic Information
| Provider Information | |||||||||
| NPI: | 1821324963 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LINGAM | ||||||||
| FirstName: | PRANATHI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14024 QUAIL POINTE DR | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731341006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054198465 | ||||||||
| FaxNumber: | 4054197745 | ||||||||
| Practice Location | |||||||||
| Address1: | 1616 S KELLY AVE | ||||||||
| Address2: | |||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730133651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052858823 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2009 | ||||||||
| LastUpdateDate: | 07/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 07/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | P6859 | TX | N | Allopathic & Osteopathic Physicians | Dermatology | 207R00000X | BP10034494 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 37247 | OK | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207N00000X | 37247 | OK | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | . | 01 | . | OTHER |