MEDICARE: PHYSICIAN UNIVERSE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1023435856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIAN UNIVERSE, PLLC

Provider Business Mailing Address
First Line	:	3800 LAKELAND LN
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-1327
Country	:	US
Telephone Number	:	248-943-7284
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 LAKELAND LN
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-1327
Country	:	US
Telephone Number	:	248-943-7284
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	DR. SHLOMO MANDEL
Credential	:	M.D.
Telephone Number	:	248-943-7284

Provider Enumeration Date	:	03/18/2014
Last Update Date	:	06/24/2014

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