Provider Demographics
NPI:1952371825
Name:MCMENAMY, KANDI (MD)
Entity Type:Individual
Prefix:DR
First Name:KANDI
Middle Name:
Last Name:MCMENAMY
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:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:1325 S. CLIFF AVE.
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1007
Practice Address - Country:US
Practice Address - Phone:605-322-4425
Practice Address - Fax:605-322-4499
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD36742080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN161221200Medicaid
MN27T86MCOtherCC SYSTEMS/BLUE PLUS
SD4700069OtherMEDICA
SD4999722OtherBCBS SD
SDHP32483OtherHEALTHPARTNERS
IA0972414Medicaid
SD603795OtherARAZ/AMERICA'S PPO
SD34573OtherSANFORD
SD6701090Medicaid
SD3674OtherDAKOTACARE
NE4700116OtherUNITEDHEALTHCARE NE MA
SD13988OtherMIDLANDS CHOICE
SD57105L003OtherTPS TRICARE
SD769221017456OtherPREFERRED ONE
SDF28130Medicare UPIN
SD2869Medicare ID - Type UnspecifiedINDIVIDUAL #
MN27T86MCOtherCC SYSTEMS/BLUE PLUS