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General NPI Number Information
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NPI Number | 1366934077
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Entity Type | Individual
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Provider Name | MOHAMED NEDHAL ALI ABDULLA MANDEEL MD
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Gender | Male
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 2231 CAREW ST
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City | FORT WAYNE
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State | IN
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Zip | 46805-4713
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Country | US
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Telephone | 260-266-7856
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Fax | 260-266-5279
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Provider Business Mailing Address
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Address Line | 11109 PARKVIEW PLAZA DR # 117
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City | FORT WAYNE
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State | IN
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Zip | 46845-1701
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Country | US
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Telephone |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301115426
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 036.156772
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 01096544A
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License Number State | IN
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