Organization
ANDREW MANDERY MD PLASTIC SURGERY LLC
Active
Organization
ANDREW MANDERY MD PLASTIC SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREW J. MANDERY MD (PHYSICIAN)
(765) 236-1290
Entity
Organization
Contact information
Practice address
1948 W BOULEVARD, KOKOMO, IN 46902-6078
(765) 236-1290
(765) 236-0420
Mailing address
1948 W BOULEVARD, KOKOMO, IN 46902-6078
(765) 236-1290
(765) 236-0420
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
01045232
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200101450B
—
IN
Enumeration date
06/17/2010
Last updated
07/02/2014
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