MEDICARE: MS. BHARGAVI MANDIPALLE 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	207Q00000X	Family Medicine Physician	01070721A	IN

General Provider Information

NPI Number	:	1538328620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BHARGAVI MANDIPALLE MD

Provider Business Mailing Address
First Line	:	PO BOX 359
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47703-0359
Country	:	US
Telephone Number	:	812-485-1220
Fax Number	:	812-485-1200

Provider Business Practice Location Address
First Line	:	1116 MILLIS AVE
Second Line	:	STE 101
City	:	BOONVILLE
State	:	IN
Zip	:	47601-2292
Country	:	US
Telephone Number	:	812-897-7175
Fax Number	:	812-897-7125

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

Provider Enumeration Date	:	06/04/2008
Last Update Date	:	07/31/2012

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