Provider Demographics
NPI:1184038572
Name:MANN, KANWALDEEP (MD)
Entity Type:Individual
Prefix:
First Name:KANWALDEEP
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KANWALDEEP
Other - Middle Name:
Other - Last Name:DHILLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5300 N INDEPENDENCE AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5555
Mailing Address - Country:US
Mailing Address - Phone:405-427-2441
Mailing Address - Fax:405-427-4741
Practice Address - Street 1:2601 SPENCER RD
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:OK
Practice Address - Zip Code:73084-3649
Practice Address - Country:US
Practice Address - Phone:405-427-2441
Practice Address - Fax:405-427-4741
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK307332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry