Provider Demographics
NPI:1851682561
Name:MANDULA, NATASHA (DPM)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:MANDULA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 N MAIN ST STE N
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-3268
Mailing Address - Country:US
Mailing Address - Phone:219-257-0255
Mailing Address - Fax:219-209-5514
Practice Address - Street 1:756 N MAIN ST STE N
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3268
Practice Address - Country:US
Practice Address - Phone:219-257-0255
Practice Address - Fax:219-209-5514
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001187A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist