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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