MEDICARE: DR. RENU MOHANDAS M.D

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	207R00000X	Internal Medicine Physician	K9134	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8CM958	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205949112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENU MOHANDAS M.D

Provider Business Mailing Address
First Line	:	209 S CHURCH ST
Second Line	:	SUITE B
City	:	LOCKHART
State	:	TX
Zip	:	78644-2713
Country	:	US
Telephone Number	:	512-376-2999
Fax Number	:	512-376-5562

Provider Business Practice Location Address
First Line	:	209 S CHURCH ST
Second Line	:	SUITE B
City	:	LOCKHART
State	:	TX
Zip	:	78644-2713
Country	:	US
Telephone Number	:	512-376-2999
Fax Number	:	512-376-5562

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	12/11/2012

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