Provider Demographics
NPI:1205149432
Name:KANKIPATI, STANKA MADHU KUMAR (MD)
Entity type:Individual
Prefix:
First Name:STANKA MADHU KUMAR
Middle Name:
Last Name:KANKIPATI
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 1:6505 MARKET ST BLDG A1
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-3457
Mailing Address - Country:US
Mailing Address - Phone:330-746-8040
Mailing Address - Fax:330-746-8025
Practice Address - Street 1:661 MAHONING AVE NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-4607
Practice Address - Country:US
Practice Address - Phone:330-746-8040
Practice Address - Fax:330-746-8025
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD449124208000000X
ORMD176098208000000X
OH35.135506208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics