Provider Demographics
NPI:1548279458
Name:MANKANI, SUSHIL K (MD, MPH)
Entity type:Individual
Prefix:
First Name:SUSHIL
Middle Name:K
Last Name:MANKANI
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13830 BALNTYN CORP PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3803
Mailing Address - Country:US
Mailing Address - Phone:704-759-2580
Mailing Address - Fax:
Practice Address - Street 1:13830 BALNTYN CORP PL
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3803
Practice Address - Country:US
Practice Address - Phone:704-759-2580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2013-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010483132083P0500X
NC2012-017012083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA73367Medicare UPIN