Provider Demographics
NPI:1174662308
Name:JEEVANANTHAM, VINODH (MD)
Entity Type:Individual
Prefix:
First Name:VINODH
Middle Name:
Last Name:JEEVANANTHAM
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 1:3400 S DOUGLAS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73150-1001
Mailing Address - Country:US
Mailing Address - Phone:405-737-7000
Mailing Address - Fax:405-272-2898
Practice Address - Street 1:3400 S DOUGLAS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73150-1001
Practice Address - Country:US
Practice Address - Phone:405-737-7000
Practice Address - Fax:405-272-2898
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01011208M00000X
OK30512207RC0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1992885545Medicaid
NC199206OtherMEDCOST
NC145HTOtherBCBS
SCQ0052MMedicaid
OK200545090AMedicaid
NC5906676Medicaid
NC9164064OtherAETNA
WV3810009020Medicaid
NC810599OtherPARTNERS
NC9164064OtherAETNA
NC145HTOtherBCBS