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General NPI Number Information
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NPI Number | 1003015660
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Entity Type | Organization
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Legal Business Name | MANDELL CARDIAC CARE CENTER PA
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 12/05/2008
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Provider Practice Location Address
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Address Line | 15300 JOG RD SUITE 202
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City | DELRAY BEACH
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State | FL
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Zip | 33446-2162
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Country | US
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Telephone | 561-455-5601
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Fax | 561-455-5602
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Provider Business Mailing Address
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Address Line | 15300 JOG RD SUITE 202
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City | DELRAY BEACH
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State | FL
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Zip | 33446-2162
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Country | US
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Telephone | 561-455-5601
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Fax | 561-455-5602
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Authorized Official
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Title or Position | PRESIDENT AND SECRETARY
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Name | DR. KENNETH BRAD MANDELL
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Credential | M.D.
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Telephone | 561-455-5601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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