Healthcare Provider Details

I. General information

NPI: 1932173788
Provider Name (Legal Business Name): DAVID M MANDELBAUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 CAMBERLY CT
GREENWOOD IN
46143-7193
US

IV. Provider business mailing address

2840 CAMBERLY CT
GREENWOOD IN
46143-7193
US

V. Phone/Fax

Practice location:
  • Phone: 317-528-6149
  • Fax:
Mailing address:
  • Phone: 317-528-6149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01030405B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: