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General NPI Number Information
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NPI Number | 1861676702
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Entity Type | Organization
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Legal Business Name | WAGIH R MANDO, MD FACS LLC
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 12/27/2007
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Provider Practice Location Address
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Address Line | 200 W ESPLANADE AVE STE 410
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City | KENNER
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State | LA
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Zip | 70065-2489
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Country | US
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Telephone | 504-464-8619
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Fax |
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Provider Business Mailing Address
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Address Line | 200 W ESPLANADE AVE STE 410
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City | KENNER
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State | LA
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Zip | 70065-2489
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Country | US
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Telephone | 504-464-8619
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. WAGIH R MANDO
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Credential | MD
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Telephone | 504-464-8619
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 09630R
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License Number State | LA
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