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General NPI Number Information
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NPI Number | 1649451857
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Entity Type | Organization
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Legal Business Name | MANGIL SEO MD PC
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 4505 SW 9TH ST
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City | DES MOINES
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State | IA
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Zip | 50315-3939
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Country | US
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Telephone | 515-287-7777
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Fax | 515-287-7114
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Provider Business Mailing Address
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Address Line | 4505 SW 9TH ST
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City | DES MOINES
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State | IA
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Zip | 50315-3939
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Country | US
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Telephone | 515-287-7777
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Fax | 515-287-7114
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Authorized Official
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Title or Position | OWNER
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Name | MANGIL SEO
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Credential | MD
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Telephone | 515-287-7111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 19652
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License Number State | IA
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