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Individual

DR. STACI A MANDROLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
7504 WESTPORT RD, LOUISVILLE, KY 40222-4108
(502) 693-2681
(502) 456-9738
Mailing address
2500 MEADOW RD, LOUISVILLE, KY 40205-2220
(502) 456-9738

Taxonomy

Speciality
Code
Description
License number
State
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
41139
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000642419
ANTHEM
KY
01
3756448000
PASSPORT ADVANTAGE
KY
01
50026942
PASSPORT
KY
05
7100094260
KY
Enumeration date
05/03/2007
Last updated
01/11/2013
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