Provider Demographics
NPI:1063542025
Name:MACHANDA, KATIE E (MD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:E
Last Name:MACHANDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7140 PORT SYLVANIA DR
Mailing Address - Street 2:SUITE 420
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1176
Mailing Address - Country:US
Mailing Address - Phone:419-843-8145
Mailing Address - Fax:419-841-7735
Practice Address - Street 1:7140 PORT SYLVANIA DR
Practice Address - Street 2:SUITE 420
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1176
Practice Address - Country:US
Practice Address - Phone:419-843-8145
Practice Address - Fax:419-841-7735
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35085743207R00000X
OH35-085743208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2638917OtherBCMH
PA1018297610001Medicaid
PA1018945270001Medicaid
OH000000221389OtherUNISON
OH363791OtherWELLCARE
OH7410792OtherAETNA
OH000000391796OtherANTHEM
OH745938OtherBUCKEYE
OH2638917Medicaid
OHMA4178461Medicare ID - Type Unspecified
OHP00478432Medicare PIN
OHMA4178462Medicare PIN
PA1018945270001Medicaid
OH2638917Medicaid