1447292172 NPI number — DR. KSHEMAL MANKODI M.D.

Table of content: DR. KSHEMAL MANKODI M.D. (NPI 1447292172)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447292172 NPI number — DR. KSHEMAL MANKODI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANKODI
Provider First Name:
KSHEMAL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447292172
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 46068
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33646-0101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-994-4749
Provider Business Mailing Address Fax Number:
813-994-0474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28959 WESLEY CHAPEL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESLEY CHAPEL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33543-3218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-994-4749
Provider Business Practice Location Address Fax Number:
813-994-0474
Provider Enumeration Date:
06/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME78449 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01-09835 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2095583 . This is a "FIRST HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00-00649 . This is a "UNITED MEDICARE COMPLETE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 200901200 . This is a "DEPARTMENT OF LABOUR ACS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 885456 . This is a "USA MANAGED CARE ORG." identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 213352 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7732052 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 213352 . This is a "STAYWELL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 213352 . This is a "HEALTHEASE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 214085-09 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 257244300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 287443 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 06089 . This is a "UNIVERSAL HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 15107 . This is a "ALL FLORIDA PPO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 49434 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5893655 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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