Madhavi Kandula, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

R8J49 Issued in MO

Practice address

845 North New Ballas Court
Suite 310
St Louis, MO 63141-7148

Phone

(314) 692-0221

Fax

(314) 692-0686

NPI assigned

Oct 11, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Nov 19, 2013 through Nov 19, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1437247566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 NORTH NEW BALLAS COURT",
            "address_2": "SUITE 310",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "631417148",
            "telephone_number": "314-692-0221",
            "fax_number": "314-692-0686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 NORTH NEW BALLAS COURT",
            "address_2": "SUITE 310",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "631417148",
            "telephone_number": "314-692-0221",
            "fax_number": "314-692-0686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANDULA",
        "first_name": "MADHAVI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MO",
            "license": "R8J49",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSMO",
            "identifier": "177308",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "199611384014",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madhu Kiran Kancherla, M.D.
• Suman Subbaraya Kandachar, MD
• Apoorva Kandakatla, MD
• Dani Kander, DO
• Kandkseniorservicesllc
• Prasanthi Kandula
• Daniel T Kane, MD
• Deborah Shipley Kane, MD
• Erin Elizabeth Kane, MD
• Jerome S Kane, R.N.

• Dermatology Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Dermatology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.