Healthcare Provider Details

I. General information

NPI: 1619048139
Provider Name (Legal Business Name): FRANK DANIEL MONGIARDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL CTR. DR. STE. 2N
HAZARD KY
41701-9466
US

IV. Provider business mailing address

200 MEDICAL CENTER DR STE. 2N
HAZARD KY
41701-9466
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-4466
  • Fax: 606-439-1941
Mailing address:
  • Phone: 606-439-4466
  • Fax: 606-439-1941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number25357
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: