Provider Demographics
NPI:1386646081
Name:POWAR, MANDEEP (MD)
Entity Type:Individual
Prefix:
First Name:MANDEEP
Middle Name:
Last Name:POWAR
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 1:1775 MCCULLOCH BLVD N
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-6549
Mailing Address - Country:US
Mailing Address - Phone:928-453-0696
Mailing Address - Fax:928-453-0816
Practice Address - Street 1:1775 MCCULLOCH BLVD N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6549
Practice Address - Country:US
Practice Address - Phone:928-453-0696
Practice Address - Fax:928-453-3660
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24843174400000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ21472Medicare ID - Type Unspecified