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General NPI Number Information
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NPI Number | 1144563305
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Entity Type | Individual
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Provider Name | AMAR B MANDALIA
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Gender | Male
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Dates
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Enumeration Date | 04/05/2013
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 13800 VETERANS WAY
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City | ORLANDO
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State | FL
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Zip | 32827-7401
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Country | US
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Telephone | 561-843-8107
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Fax |
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Provider Business Mailing Address
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Address Line | 13800 VETERANS WAY
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City | ORLANDO
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State | FL
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Zip | 32827-7401
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Country | US
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Telephone | 561-843-8107
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 4301109788
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License Number State | MI
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