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NPI Code Detail

MEDICARE: GREGORY MANDILE D.O.

MEDICARE: GREGORY MANDILE D.O.
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
1208M00000XHospitalist PhysicianOS16535FL
2207R00000XInternal Medicine PhysicianOS16535FL

Other Identifiers

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

General Provider Information

NPI Number : 1629519038
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY MANDILE D.O.
Provider Business Mailing Address
First Line : 2413 LAKEWOOD RANCH BLVD N
Second Line :
City : LAKEWOOD RANCH
State : FL
Zip : 34240-7025
Country : US
Telephone Number : 941-499-2700
Fax Number : 941-487-0474
Provider Business Practice Location Address
First Line : 8130 LAKEWOOD MAIN ST STE 103
Second Line :
City : LAKEWOOD RANCH
State : FL
Zip : 34202-5068
Country : US
Telephone Number : 941-499-2700
Fax Number : 941-487-0474
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2017
Last Update Date : 02/03/2021

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Directions to “ GREGORY MANDILE D.O.” Practice Location

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