MEDICARE: LEELA S MUNDRA MD

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	DR.0074456	CO
2	2086S0122X	Plastic and Reconstructive Surgery Physician	DR.0074456	CO

General Provider Information

NPI Number	:	1164929923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEELA S MUNDRA MD

Provider Business Mailing Address
First Line	:	PO BOX 110429
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80042-0429
Country	:	US
Telephone Number	:
Fax Number	:

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	11/03/2025

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