Basic Information
| Provider Information | |||||||||
| NPI: | 1063542025 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACHANDA | ||||||||
| FirstName: | KATIE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7140 PORT SYLVANIA DR | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436171176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198438145 | ||||||||
| FaxNumber: | 4198417735 | ||||||||
| Practice Location | |||||||||
| Address1: | 7140 PORT SYLVANIA DR | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436171176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198438145 | ||||||||
| FaxNumber: | 4198417735 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 09/28/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 35-085743 | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 35085743 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000391796 | 01 | OH | ANTHEM | OTHER | 2638917 | 01 | OH | BCMH | OTHER | 1018297610001 | 05 | PA | MEDICAID | 1018945270001 | 05 | PA | MEDICAID | 000000221389 | 01 | OH | UNISON | OTHER | 2638917 | 05 | OH | MEDICAID | 745938 | 01 | OH | BUCKEYE | OTHER | 363791 | 01 | OH | WELLCARE | OTHER | 7410792 | 01 | OH | AETNA | OTHER |