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General NPI Number Information
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NPI Number | 1629399266
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Entity Type | Organization
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Legal Business Name | ANDREW MANDERY MD PLASTIC SURGERY LLC
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Dates
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Enumeration Date | 06/17/2010
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Last Update Date | 07/02/2014
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Provider Practice Location Address
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Address Line | 1948 W BOULEVARD
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City | KOKOMO
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State | IN
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Zip | 46902-6078
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Country | US
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Telephone | 765-236-1290
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Fax | 765-236-0420
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Provider Business Mailing Address
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Address Line | 1948 W BOULEVARD
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City | KOKOMO
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State | IN
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Zip | 46902-6078
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Country | US
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Telephone | 765-236-1290
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Fax | 765-236-0420
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ANDREW J. MANDERY
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Credential | MD
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Telephone | 765-236-1290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 01045232
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License Number State | IN
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