Basic Information
| Provider Information | |||||||||
| NPI: | 1093832131 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DANDEKAR | ||||||||
| FirstName: | MONISHA | ||||||||
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| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14275 MIDWAY RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750013614 | ||||||||
| CountryCode: | US | ||||||||
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| FaxNumber: | 6102714245 | ||||||||
| Practice Location | |||||||||
| Address1: | 10101 RENNER BLVD | ||||||||
| Address2: | SUTIE A | ||||||||
| City: | LENEXA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662199752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664555305 | ||||||||
| FaxNumber: | 8666915318 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2007 | ||||||||
| LastUpdateDate: | 10/12/2016 | ||||||||
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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 | 390200000X | 4301087859 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207ZP0102X | 0437619 | KS | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | 2014033465 | MO | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 201105190A | 05 | KS | MEDICAID | 0437619 | 01 | KS | KANSAS LICENSE | OTHER | 1093832131 | 05 | MO | MEDICAID | 2014033465 | 01 | MO | MISSOURI LICENSE | OTHER |