MEDICARE: KSHEMAL P MANKODI MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME78449	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588932966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KSHEMAL P MANKODI MD PA

Provider Business Mailing Address
First Line	:	28959 WESLEY CHAPEL BLVD
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-3218
Country	:	US
Telephone Number	:	813-994-4749
Fax Number	:	813-994-0474

Provider Business Practice Location Address
First Line	:	28959 WESLEY CHAPEL BLVD
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-3218
Country	:	US
Telephone Number	:	813-994-4749
Fax Number	:	813-994-0474

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KSHEMAL MANKODI
Credential	:	M.D.
Telephone Number	:	813-994-4749

Provider Enumeration Date	:	12/13/2011
Last Update Date	:	02/02/2012

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