MEDICARE: MANGAHAS MEDICAL CARE, P.C.

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	261QP2300X	Primary Care Clinic/Center	01045012A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000280536	OTHER	IN	ANTHEM
2	0005078527	OTHER	IN	AETNA
3	0090000883	OTHER	IL	BCBS OF ILLINOIS

General Provider Information

NPI Number	:	1417063470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANGAHAS MEDICAL CARE, P.C.

Provider Business Mailing Address
First Line	:	521 W CHICAGO AVE
Second Line	:
City	:	EAST CHICAGO
State	:	IN
Zip	:	46312-3206
Country	:	US
Telephone Number	:	219-397-6903
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 W CHICAGO AVE
Second Line	:
City	:	EAST CHICAGO
State	:	IN
Zip	:	46312-3206
Country	:	US
Telephone Number	:	219-397-6903
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MYLENE MANGAHAS
Credential	:	MD
Telephone Number	:	219-397-6903

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	08/22/2020

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Directions to “MANGAHAS MEDICAL CARE, P.C. ” Practice Location

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