Basic Information
| Provider Information | |||||||||
| NPI: | 1992741094 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WAINGANKAR | ||||||||
| FirstName: | GAURI | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 268988 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731268988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056056141 | ||||||||
| FaxNumber: | 4056056244 | ||||||||
| Practice Location | |||||||||
| Address1: | 1145 W I 240 SERVICE RD | ||||||||
| Address2: | SUITE F100 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731392171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056056141 | ||||||||
| FaxNumber: | 4056056244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 10/29/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 13381 | OK | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 13381 | OK | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 347345700 | 01 | OK | DEPT OF LABOR | OTHER | 100021090A | 05 | OK | MEDICAID | 4472694 | 01 | OK | AETNA | OTHER |