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NPI Code Detail

MEDICARE: ROBBIE THOMAS MANGALASSERIL M.D.

MEDICARE: ROBBIE THOMAS MANGALASSERIL M.D.
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
1174400000XSpecialist
2207RC0000XCardiovascular Disease Physician2015030667MO

General Provider Information

NPI Number : 1467681486
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBBIE THOMAS MANGALASSERIL M.D.
Provider Business Mailing Address
First Line : PO BOX 4046
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65808-4046
Country : US
Telephone Number : 417-269-7241
Fax Number : 417-269-7567
Provider Business Practice Location Address
First Line : 1150 STATE HIGHWAY 248 STE 200
Second Line :
City : BRANSON
State : MO
Zip : 65616-4186
Country : US
Telephone Number : 417-336-4112
Fax Number : 417-335-4684
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2009
Last Update Date : 01/10/2019

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