MEDICARE: LEELA MUNDRA MD, PLLC

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	208200000X	Plastic Surgery Physician

General Provider Information

NPI Number	:	1063218782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEELA MUNDRA MD, PLLC

Provider Business Mailing Address
First Line	:	3814 GUNN HWY STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-8789
Country	:	US
Telephone Number	:	303-418-2277
Fax Number	:	303-418-2204

Provider Business Practice Location Address
First Line	:	36 STEELE ST STE 200
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-5710
Country	:	US
Telephone Number	:	303-418-2277
Fax Number	:	303-418-2204

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	LEELA MUNDRA
Credential	:	MD
Telephone Number	:	305-857-7707

Provider Enumeration Date	:	02/22/2025
Last Update Date	:	05/13/2025

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