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General NPI Number Information
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NPI Number | 1457580680
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Entity Type | Individual
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Provider Name | ASHVARYA MANGLA MD
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Gender | Male
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Dates
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Enumeration Date | 07/09/2009
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 1653 W CONGRESS PARWAY 3-KELLOGG, DIVISION OF CARDIOLOGY
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City | CHICAGO
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State | IL
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Zip | 60612
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Country | US
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Telephone | 312-942-8771
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Fax | 312-942-5829
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Provider Business Mailing Address
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Address Line | 233 E WACKER DR APT 412
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City | CHICAGO
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State | IL
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Zip | 60601-5104
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Country | US
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Telephone | 773-575-4327
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 036129310
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 036129310
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License Number State | IL
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