Healthcare Provider Details

I. General information

NPI: 1619962693
Provider Name (Legal Business Name): MIRIAM B MANDEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29000 CENTER RIDGE RD
WESTLAKE OH
44145-5293
US

IV. Provider business mailing address

PO BOX 39155
CLEVELAND OH
44139-0155
US

V. Phone/Fax

Practice location:
  • Phone: 440-835-8000
  • Fax:
Mailing address:
  • Phone: 440-542-5023
  • Fax: 440-542-5029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35082339M
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: