Healthcare Provider Details

I. General information

NPI: 1174662308
Provider Name (Legal Business Name): VINODH JEEVANANTHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 S DOUGLAS BLVD SUITE 200
OKLAHOMA CITY OK
73150-1001
US

IV. Provider business mailing address

3400 S DOUGLAS BLVD SUITE 200
OKLAHOMA CITY OK
73150-1001
US

V. Phone/Fax

Practice location:
  • Phone: 405-737-7000
  • Fax: 405-272-2898
Mailing address:
  • Phone: 405-737-7000
  • Fax: 405-272-2898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2007-01011
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number30512
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: