Healthcare Provider Details

I. General information

NPI: 1619323466
Provider Name (Legal Business Name): DAVID R MANDY DO, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46600 ROMEO PLANK RD SUITE 4
MACOMB MI
48044-5741
US

IV. Provider business mailing address

46600 ROMEO PLANK RD SUITE 4
MACOMB MI
48044-5741
US

V. Phone/Fax

Practice location:
  • Phone: 586-228-5437
  • Fax: 586-228-7520
Mailing address:
  • Phone: 586-228-5437
  • Fax: 586-228-7520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID R MANDY
Title or Position: OWNER
Credential: D.O
Phone: 586-228-5437