Individual
DR. MANGA DEVI KODALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4055 GATEWAY BLVD, NEWBURGH, IN 47630-8947
(812) 858-3051
(812) 858-3060
Mailing address
PO BOX 3868, EVANSVILLE, IN 47737-3868
(812) 450-6815
(812) 450-6822
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
17645
MS
207R00000X
Internal Medicine Physician
ME99614
FL
207RH0003X
Hematology & Oncology Physician
Primary
01072479A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00126843
—
MS
05
—
279823900
—
FL
Enumeration date
06/09/2006
Last updated
06/05/2013
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