MEDICARE: DR. KSHEMAL MANKODI 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	207Q00000X	Family Medicine Physician	ME78449	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	00-00649	OTHER	FL	UNITED MEDICARE COMPLETE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01-09835	OTHER	FL	UNITED HEALTHCARE
2	2095583	OTHER	FL	FIRST HEALTH
4	200901200	OTHER	FL	DEPARTMENT OF LABOUR ACS
5	885456	OTHER	FL	USA MANAGED CARE ORG.
6	213352	OTHER	FL	WELLCARE
7	7732052	OTHER	FL	AETNA
8	213352	OTHER	FL	STAYWELL
9	213352	OTHER	FL	HEALTHEASE
10	214085-09	OTHER	FL	AMERIGROUP
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	287443	OTHER	FL	AVMED
13	06089	OTHER	FL	UNIVERSAL HEALTHCARE
14	15107	OTHER	FL	ALL FLORIDA PPO
15	49434	OTHER	FL	BLUE CROSS BLUE SHIELD
16	5893655	OTHER	FL	CIGNA

General Provider Information

NPI Number	:	1447292172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KSHEMAL MANKODI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 46068
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33646-0101
Country	:	US
Telephone Number	:	813-994-4749
Fax Number	:	813-994-0474

Provider Business Practice Location Address
First Line	:	28959 WESLEY CHAPEL BLVD
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-3218
Country	:	US
Telephone Number	:	813-994-4749
Fax Number	:	813-994-0474

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

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	11/04/2011

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