Healthcare Provider Details

I. General information

NPI: 1922200435
Provider Name (Legal Business Name): GEETHA BHAVANI KANDIMALA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 36TH AVE NW STE 200
NORMAN OK
73072-2477
US

IV. Provider business mailing address

2709 WARWICK PL
EDMOND OK
73013-6553
US

V. Phone/Fax

Practice location:
  • Phone: 405-307-5700
  • Fax:
Mailing address:
  • Phone: 580-919-5361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number26013
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number26013
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: