National Provider Identifier Database

ANDREW MANDERY MD PLASTIC SURGERY LLC
Plastic and Reconstructive Surgery


Contact Information

ANDREW MANDERY MD PLASTIC SURGERY LLC
1948 W BOULEVARD
KOKOMO, IN46902-6078
Phone: 765-236-1290
Fax: 765-236-0420
Website:
Specialty Taxonomy Code
* Plastic and Reconstructive Surgery 2086S0122X

* Indicates primary specialty

NPI Profile & details for ANDREW MANDERY MD PLASTIC SURGERY LLC

NPI Number 1629399266
Legal business name
LBN
ANDREW MANDERY MD PLASTIC SURGERY LLC
Authorized official ANDREW MANDERY - (PHYSICIAN)
Entity Organization
Organization subpart No
Enumeration date 06/17/2010
Last updated 07/02/2014 - About 12 years ago
Sole proprietor1 Not specified
Identifiers
  • IN License #: 01045232
  • IN Medicaid: 200101450B

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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