MEDICARE: MANGESH KANVINDE

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	208D00000X	General Practice Physician	01059611A	IN
2	208D00000X	General Practice Physician	35076521	OH
3	208D00000X	General Practice Physician	ME96979	FL
4	208D00000X	General Practice Physician	39807	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	P00381873	OTHER	OH	RAILROAD MEDICARE
9	P00600867	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000221371	OTHER	OH	UNISON
2	000000510664	OTHER	OH	ANTHEM ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	422454	OTHER	OH	WELLCARE
5	733744	OTHER	OH	BUCKEYE
6	7496427	OTHER	OH	AETNA
8	0304914	OTHER	OH	BCMH

General Provider Information

NPI Number	:	1164493623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANGESH KANVINDE

Provider Business Mailing Address
First Line	:	361 CROSS ROADS BLVD
Second Line	:
City	:	COLD SPRING
State	:	KY
Zip	:	41076-2194
Country	:	US
Telephone Number	:	859-474-0374
Fax Number	:

Provider Business Practice Location Address
First Line	:	361 CROSS ROADS BLVD
Second Line	:
City	:	COLD SPRING
State	:	KY
Zip	:	41076
Country	:	US
Telephone Number	:	859-474-0374
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	05/21/2018

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Directions to “ MANGESH KANVINDE ” Practice Location

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