Healthcare Provider Details

I. General information

NPI: 1063218782
Provider Name (Legal Business Name): LEELA MUNDRA MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 STEELE ST STE 200
DENVER CO
80206-5710
US

IV. Provider business mailing address

3814 GUNN HWY STE A
TAMPA FL
33618-8789
US

V. Phone/Fax

Practice location:
  • Phone: 303-418-2277
  • Fax: 303-418-2204
Mailing address:
  • Phone: 303-418-2277
  • Fax: 303-418-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LEELA MUNDRA
Title or Position: PHYSICIAN
Credential: MD
Phone: 305-857-7707