Provider Demographics
NPI:1457808644
Name:BRAR, MANDEEP (NP)
Entity Type:Individual
Prefix:
First Name:MANDEEP
Middle Name:
Last Name:BRAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W PATERSON ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-2557
Mailing Address - Country:US
Mailing Address - Phone:269-349-2641
Mailing Address - Fax:269-488-8972
Practice Address - Street 1:1201 MICHIGAN AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1580
Practice Address - Country:US
Practice Address - Phone:574-722-4921
Practice Address - Fax:574-739-0520
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704347087363LF0000X
IN71006503A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001051082OtherANTHEM
INP01727211OtherRAILROAD MEDICARE
IN201391250Medicaid
IN940670055Medicare PIN