Provider Demographics
NPI:1093832131
Name:DANDEKAR, MONISHA
Entity Type:Individual
Prefix:DR
First Name:MONISHA
Middle Name:
Last Name:DANDEKAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:10101 RENNER BLVD
Practice Address - Street 2:SUTIE A
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-9752
Practice Address - Country:US
Practice Address - Phone:866-455-5305
Practice Address - Fax:866-691-5318
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0437619207ZP0102X
MI4301087859390200000X
MO2014033465207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201105190AMedicaid
MO2014033465OtherMISSOURI LICENSE
KS0437619OtherKANSAS LICENSE
MO1093832131Medicaid
KS662A00008Medicare PIN
MO2014033465OtherMISSOURI LICENSE