MEDICARE: DR. LARRY MANDERS 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	207L00000X	Anesthesiology Physician	4301105804	MI
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	68860-20	WI
3	207L00000X	Anesthesiology Physician	35C.003363	OH
4	207LP2900X	Pain Medicine (Anesthesiology) Physician	35C.003363	OH

General Provider Information

NPI Number	:	1710393970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY MANDERS MD

Provider Business Mailing Address
First Line	:	3000 ARLINGTON AVE STOP 1108
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-2595
Country	:	US
Telephone Number	:	419-383-5322
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 ARLINGTON AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-2595
Country	:	US
Telephone Number	:	419-383-3556
Fax Number	:	419-383-3550

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

Provider Enumeration Date	:	07/09/2014
Last Update Date	:	01/07/2026

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