MEDICARE: SHLOMO S. MANDEL 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
1	2083X0100X	Occupational Medicine Physician	4301048723	MI
2	207R00000X	Internal Medicine Physician	4301048723	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MI3973577	OTHER	MI	MEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number	:	1952477325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHLOMO S. MANDEL M.D.

Provider Business Mailing Address
First Line	:	311 MACK AVE
Second Line	:	5TH FLOOR
City	:	DETROIT
State	:	MI
Zip	:	48201
Country	:	US
Telephone Number	:	313-916-2436
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 MACK AVE FL 5
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-2466
Country	:	US
Telephone Number	:	313-916-2436
Fax Number	:

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/21/2022

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Directions to “ SHLOMO S. MANDEL M.D.” Practice Location

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