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General NPI Number Information
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NPI Number | 1366806226
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Entity Type | Individual
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Provider Name | MANDAKINI VENKATRAMANI
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Gender | Female
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Dates
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Enumeration Date | 04/07/2016
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 601 JOHN ST STE M-283A
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City | KALAMAZOO
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State | MI
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Zip | 49007-5341
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Country | US
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Telephone | 269-349-7696
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Fax |
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Provider Business Mailing Address
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Address Line | 11100 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44106-1716
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Country | US
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Telephone |
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Fax |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301513662
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License Number State | MI
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