Provider Demographics
NPI:1164654307
Name:MANDADI, MOUNIKA (MD)
Entity Type:Individual
Prefix:
First Name:MOUNIKA
Middle Name:
Last Name:MANDADI
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 1:5200 COMMERCE CROSSINGS DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2182
Mailing Address - Country:US
Mailing Address - Phone:502-253-4900
Mailing Address - Fax:
Practice Address - Street 1:4003 KRESGE WAY STE 500
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5603
Practice Address - Country:US
Practice Address - Phone:502-897-1166
Practice Address - Fax:502-897-1461
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45366207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK129880OtherMEDICARE
KY45366OtherLICENSE
KY7100142880Medicaid