Provider Demographics
NPI:1952360919
Name:PABLA, MANINDER (MD)
Entity Type:Individual
Prefix:
First Name:MANINDER
Middle Name:
Last Name:PABLA
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 1:1010 CARONDELET DR STE 121
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4859
Mailing Address - Country:US
Mailing Address - Phone:816-912-2100
Mailing Address - Fax:636-438-0430
Practice Address - Street 1:17065 S OUTER RD
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-2165
Practice Address - Country:US
Practice Address - Phone:816-348-1850
Practice Address - Fax:636-438-0430
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004024755207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209408202Medicaid
KS100288780DMedicaid
BP9053810OtherDEA
BP9053810OtherDEA
I21263Medicare UPIN
MO209408202Medicaid