MEDICARE: DR. ANGELOS N MANGANIOTIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	ME81903	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194720268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELOS N MANGANIOTIS M.D.

Provider Business Mailing Address
First Line	:	400 CELEBRATION PL STE A260
Second Line	:
City	:	CELEBRATION
State	:	FL
Zip	:	34747-4970
Country	:	US
Telephone Number	:	407-764-4079
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 CELEBRATION PL STE A260
Second Line	:
City	:	CELEBRATION
State	:	FL
Zip	:	34747-4970
Country	:	US
Telephone Number	:	407-764-4079
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2025

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