MEDICARE: MANDEEP GAREWAL MD

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	2084N0400X	Neurology Physician	2005027549	MO
2	2084D0003X	Diagnostic Neuroimaging (Psychiatry & Neurology) Physician	ME095705	FL

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
2	ME0095705	OTHER	FL	LICENSE

General Provider Information

NPI Number	:	1700997707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDEEP GAREWAL MD

Provider Business Mailing Address
First Line	:	325 CLYDE MORRIS BLVD STE 390
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8179
Country	:	US
Telephone Number	:	386-676-6335
Fax Number	:	386-256-7629

Provider Business Practice Location Address
First Line	:	8 MIRROR LAKE DRIVE
Second Line	:	SUITE A
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174
Country	:	US
Telephone Number	:	386-673-2500
Fax Number	:	386-673-3204

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	11/03/2022

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