Provider Demographics
NPI:1376834234
Name:SADHIR, MANDAKINI (MD)
Entity type:Individual
Prefix:
First Name:MANDAKINI
Middle Name:
Last Name:SADHIR
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 1:740 SOUTH LIMESTONE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40539
Mailing Address - Country:US
Mailing Address - Phone:859-218-5183
Mailing Address - Fax:859-323-3795
Practice Address - Street 1:# 740
Practice Address - Street 2:SOUTH LIMESTONE
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0284
Practice Address - Country:US
Practice Address - Phone:859-218-5183
Practice Address - Fax:859-323-3795
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55687208000000X, 2080A0000X
KY46890208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1376834234Medicaid
WI68086 0914Medicare PIN
WI73601 2153Medicare PIN