Organization
ANDREW J MANDERY MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREW JAY MANDERY M.D. (OWNER)
(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
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
148380
MEDICARE PROVIDER NO.
—
Enumeration date
09/20/2007
Last updated
09/20/2007
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