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General NPI Number Information
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NPI Number | 1255492104
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Entity Type | Individual
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Provider Name | KELLY ANN MANDAGERE M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 07/20/2010
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Provider Practice Location Address
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Address Line | 892 W SOUTH BOULDER RD
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City | LOUISVILLE
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State | CO
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Zip | 80027-2453
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Country | US
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Telephone | 303-586-5200
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Fax | 303-586-5201
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Provider Business Mailing Address
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Address Line | 892 W SOUTH BOULDER RD
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City | LOUISVILLE
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State | CO
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Zip | 80027-2453
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Country | US
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Telephone | 303-586-5200
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Fax | 303-586-5201
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 45001
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 45001
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License Number State | CO
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