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General NPI Number Information
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NPI Number | 1417063470
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Entity Type | Organization
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Legal Business Name | MANGAHAS MEDICAL CARE, P.C.
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 521 W CHICAGO AVE
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City | EAST CHICAGO
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State | IN
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Zip | 46312-3206
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Country | US
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Telephone | 219-397-6903
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Fax |
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Provider Business Mailing Address
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Address Line | 521 W CHICAGO AVE
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City | EAST CHICAGO
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State | IN
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Zip | 46312-3206
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Country | US
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Telephone | 219-397-6903
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MYLENE MANGAHAS
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Credential | MD
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Telephone | 219-397-6903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 01045012A
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License Number State | IN
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