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NPI Code Detail

MEDICARE: DR. INDIRA P ANDHOLE MD

MEDICARE: DR. INDIRA P ANDHOLE 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
1208000000XPediatrics Physician40289WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184632747
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. INDIRA P ANDHOLE MD
Provider Business Mailing Address
First Line : 3301 W FOREST HOME AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53215-2843
Country : US
Telephone Number : 414-647-6326
Fax Number :
Provider Business Practice Location Address
First Line : 1881 CHICAGO ST
Second Line :
City : DEPERE
State : WI
Zip : 54115
Country : US
Telephone Number : 920-403-8000
Fax Number : 920-403-8204
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2006
Last Update Date : 03/07/2023

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Directions to “ DR. INDIRA P ANDHOLE MD” Practice Location

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