Provider Demographics
NPI:1447292172
Name:MANKODI, KSHEMAL (MD)
Entity type:Individual
Prefix:DR
First Name:KSHEMAL
Middle Name:
Last Name:MANKODI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 46068
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33646-0101
Mailing Address - Country:US
Mailing Address - Phone:813-994-4749
Mailing Address - Fax:813-994-0474
Practice Address - Street 1:28959 WESLEY CHAPEL BLVD
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-3218
Practice Address - Country:US
Practice Address - Phone:813-994-4749
Practice Address - Fax:813-994-0474
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78449207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01-09835OtherUNITED HEALTHCARE
FL2095583OtherFIRST HEALTH
FL00-00649OtherUNITED MEDICARE COMPLETE
FL200901200OtherDEPARTMENT OF LABOUR ACS
FL885456OtherUSA MANAGED CARE ORG.
FL213352OtherWELLCARE
FL7732052OtherAETNA
FL213352OtherSTAYWELL
FL213352OtherHEALTHEASE
FL214085-09OtherAMERIGROUP
FL257244300Medicaid
FL287443OtherAVMED
FL06089OtherUNIVERSAL HEALTHCARE
FL15107OtherALL FLORIDA PPO
FL49434OtherBLUE CROSS BLUE SHIELD
FL5893655OtherCIGNA
FL49434Medicare ID - Type Unspecified
FL15107OtherALL FLORIDA PPO