MEDICARE: MICHELE MANGUM 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	2084N0400X	Neurology Physician	200100262	NC
2	2084N0400X	Neurology Physician	11868	SC

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	:	1417952169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE MANGUM M.D.

Provider Business Mailing Address
First Line	:	1 INDEPENDENCE PT
Second Line	:	SUITE 212
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4545
Country	:	US
Telephone Number	:	864-797-6044
Fax Number	:	864-797-6198

Provider Business Practice Location Address
First Line	:	701 GROVE RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29605-4210
Country	:	US
Telephone Number	:	864-455-7000
Fax Number	:

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

Provider Enumeration Date	:	06/18/2005
Last Update Date	:	09/05/2013

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Directions to “ MICHELE MANGUM M.D.” Practice Location

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