Individual
PRASANTI MANDALAPU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
933 E PIERCE ST, COUNCIL BLUFFS, IA 51503-4626
(712) 396-4360
(712) 396-7069
Mailing address
PO BOX 3755, OMAHA, NE 68103-0755
(402) 354-2100
(402) 354-6171
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
41116
IA
208M00000X
Hospitalist Physician
Primary
41116
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100263273-00
—
NE
05
—
1518163831
—
IA
01
—
41116
MEDICAL LICENSE
IA
Enumeration date
06/24/2007
Last updated
08/02/2017
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