Provider Demographics
NPI:1285655415
Name:SANDER-PRATHER, MANDY M (MD)
Entity Type:Individual
Prefix:DR
First Name:MANDY
Middle Name:M
Last Name:SANDER-PRATHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:M
Other - Last Name:SANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10301 HICKMAN MILLS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64137-1659
Mailing Address - Country:US
Mailing Address - Phone:816-763-5446
Mailing Address - Fax:816-763-8426
Practice Address - Street 1:5721 W 119TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3722
Practice Address - Country:US
Practice Address - Phone:816-763-5446
Practice Address - Fax:816-763-8426
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0431940207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201371002Medicaid
KS200399740BMedicaid
MO201371002Medicaid