Basic Information
| Provider Information | |||||||||
| NPI: | 1538328620 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANDIPALLE | ||||||||
| FirstName: | BHARGAVI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 359 | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477030359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124851220 | ||||||||
| FaxNumber: | 8124851200 | ||||||||
| Practice Location | |||||||||
| Address1: | 1116 MILLIS AVE | ||||||||
| Address2: | STE 101 | ||||||||
| City: | BOONVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 476012292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128977175 | ||||||||
| FaxNumber: | 8128977125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2008 | ||||||||
| LastUpdateDate: | 07/31/2012 | ||||||||
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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 | 207Q00000X | 01070721A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.