Organization
GEETHA B KANDIMALA MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEETHA BHAVANI KANDIMALA MD (PRESIDENT)
(580) 919-5361
Entity
Organization
Contact information
Practice address
5606 SW LEE BLVD, 302, LAWTON, OK 73505-9688
(580) 919-5361
Mailing address
5606 SW LEE BLVD, 302, LAWTON, OK 73505-9688
(580) 919-5361
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
26013
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200447100A
—
OK
Enumeration date
06/07/2012
Last updated
09/27/2012
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