Provider Demographics
NPI:1750662813
Name:KALIRAO, MANDEEP KAUR (MD)
Entity Type:Individual
Prefix:DR
First Name:MANDEEP
Middle Name:KAUR
Last Name:KALIRAO
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 1:331 E PUETZ RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-3254
Mailing Address - Country:US
Mailing Address - Phone:414-570-3590
Mailing Address - Fax:
Practice Address - Street 1:331 E PUETZ RD
Practice Address - Street 2:SUITE 104
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-3254
Practice Address - Country:US
Practice Address - Phone:414-570-3590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN57789207Q00000X
WI65836207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1750662813Medicaid
WI1750662813Medicaid