Provider Demographics
NPI:1558705285
Name:MANI, VIBITHA (MD)
Entity Type:Individual
Prefix:
First Name:VIBITHA
Middle Name:
Last Name:MANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 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:405-470-2590
Mailing Address - Fax:405-470-0619
Practice Address - Street 1:9417 N COUNCIL RD STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-6207
Practice Address - Country:US
Practice Address - Phone:405-470-2590
Practice Address - Fax:405-470-0619
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29972208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics