Individual ProviderMouna KodaliStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address945 N 12th St, Milwaukee, WI 53233-1305(414) 219-2000(414) 219-5725PECOS EnrollmentBased on the most recent information from CMS, provider Mouna Kodali is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1275116840Provider TypeIndividualFull NameKodali, MounaTitleDr.CredentialMDGenderFemaleSole ProprietorYesEnumeration Date5/3/2021Last Updated5/3/2021Contact InformationPractice LocationPractice Address945 N 12th St, Milwaukee, WI 53233-1305Phone(414) 219-2000FaxUnlisted FaxMailing LocationMailing Address945 N 12th St, Milwaukee, WI 53233-1305Phone(414) 219-5725FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer