Individual
MADHAVI REDDY MANDALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
202 N DIVISION ST STE 301, AUBURN, WA 98001-4939
(253) 833-7256
Mailing address
202 N DIVISION ST STE 301, AUBURN, WA 98001-4939
(253) 833-7256
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036114994
IL
207R00000X
Internal Medicine Physician
Primary
MD60253695
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036114994
—
IL
01
—
CA1439
RR GROUP NUMBER
IL
01
—
CE9335
RR GROUP NUMBER
IL
01
—
P00393076
RR MEDICARE
IL
01
—
P00406649
RR MEDICARE NUMBER
IL
Enumeration date
08/16/2006
Last updated
09/27/2012
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