| Doctor Name: | PREMAL KHETIA |
| NPI Number: | 1285667295 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 23518 |
| Business Practice Address: | 1023 E Cherry St Suite B Cushing, OK - 740234105 |
| Business Phone Number: | 9182251165 |
| Business Fax Number: | 9182251953 |
| Mailing Address: | 1145 S Utica Ave, Suite 110 TULSA |
| State: | OK |
| Postal Code: | 741044000 |
| Phone Number: | 9185793825 |
| Fax Number: | 9185791262 |
| NPI Enumeration Date: | 07/10/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207YS0123X |
| License Number: | 23518 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Otolaryngology |
| Taxonomy Specialization: | Facial Plastic Surgery |
| Taxonomy Definition: | An otolaryngologist who specializes in facial plastic surgery. |