Provider Demographics
NPI:1770636854
Name:MANDANIS, CHRISTOS E (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOS
Middle Name:E
Last Name:MANDANIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 N HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3219
Mailing Address - Country:US
Mailing Address - Phone:316-616-3333
Mailing Address - Fax:316-616-0974
Practice Address - Street 1:925 N HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3219
Practice Address - Country:US
Practice Address - Phone:316-616-3333
Practice Address - Fax:316-616-0974
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-33570207RC0000X, 207RC0001X
WAMD00040025207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200611360CMedicaid
WA8297434Medicaid
KS200611360AMedicaid
AZ924575Medicaid
OK200542020AMedicaid
KS200611360CMedicaid
KS004052008Medicare PIN
OK200542020AMedicaid
KSKA2473009Medicare PIN
KS200611360AMedicaid