Provider Demographics
NPI:1922200435
Name:KANDIMALA, GEETHA BHAVANI (MD)
Entity type:Individual
Prefix:
First Name:GEETHA
Middle Name:BHAVANI
Last Name:KANDIMALA
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 1:2709 WARWICK PL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6553
Mailing Address - Country:US
Mailing Address - Phone:580-919-5361
Mailing Address - Fax:
Practice Address - Street 1:2821 36TH AVE NW STE 200
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2477
Practice Address - Country:US
Practice Address - Phone:405-307-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK260132084S0012X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP1-0017760OtherINSTITUTIONAL PERMIT
OK200199360AMedicaid