Provider Demographics
NPI:1295705663
Name:AGGARWAL, VISHAL (MD)
Entity type:Individual
Prefix:DR
First Name:VISHAL
Middle Name:
Last Name:AGGARWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3336 E 32ND ST
Mailing Address - Street 2:STE 200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-4442
Mailing Address - Country:US
Mailing Address - Phone:918-742-4900
Mailing Address - Fax:918-742-4901
Practice Address - Street 1:3336 E 32 STREET
Practice Address - Street 2:200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7413
Practice Address - Country:US
Practice Address - Phone:918-742-4900
Practice Address - Fax:918-742-4900
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23724207RG0300X, 207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200026000AMedicaid
243415503Medicare ID - Type Unspecified
OK200026000AMedicaid
H73722Medicare UPIN