MEDICARE: JOSHUA LEE MANGHELLI D.O.

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	208600000X	Surgery Physician	02006817A	IN
2	390200000X	Student in an Organized Health Care Education/Training Program	11018189A	IN
3	2086X0206X	Surgical Oncology Physician	02006817A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356721567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA LEE MANGHELLI D.O.

Provider Business Mailing Address
First Line	:	6626 E 75TH ST STE 500
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2890
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7120 CLEARVISTA DR STE 3200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-1782
Country	:	US
Telephone Number	:	317-621-7780
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2015
Last Update Date	:	12/04/2023

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