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Individual

DR. KELLY ANN MANDAGERE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
892 W SOUTH BOULDER RD, LOUISVILLE, CO 80027-2453
(303) 586-5200
(303) 586-5201
Mailing address
892 W SOUTH BOULDER RD, LOUISVILLE, CO 80027-2453
(303) 586-5200
(303) 586-5201

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
45001
CO
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
45001
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01159305
CO
05
81287895
CO
Enumeration date
12/13/2006
Last updated
07/20/2010
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