MEDICARE: VIBITHA MANI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	29972	OK

General Provider Information

NPI Number	:	1558705285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIBITHA MANI MD

Provider Business Mailing Address
First Line	:	5300 N INDEPENDENCE AVE STE 280
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-5555
Country	:	US
Telephone Number	:	405-470-2590
Fax Number	:	405-470-0619

Provider Business Practice Location Address
First Line	:	9417 N COUNCIL RD STE 200
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-6207
Country	:	US
Telephone Number	:	405-470-2590
Fax Number	:	405-470-0619

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2013
Last Update Date	:	04/30/2019

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Directions to “ VIBITHA MANI MD” Practice Location

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