Provider Demographics
NPI:1063218782
Name:LEELA MUNDRA MD, PLLC
Entity type:Organization
Organization Name:LEELA MUNDRA MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LEELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-857-7707
Mailing Address - Street 1:3814 GUNN HWY STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-8789
Mailing Address - Country:US
Mailing Address - Phone:303-418-2277
Mailing Address - Fax:303-418-2204
Practice Address - Street 1:36 STEELE ST STE 200
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5710
Practice Address - Country:US
Practice Address - Phone:303-418-2277
Practice Address - Fax:303-418-2204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-22
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty