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NPI Code Detail

MEDICARE: DR. EUGENE MANDREA M.D.

MEDICARE:  DR. EUGENE  MANDREA  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
1207N00000XDermatology Physician036-038229IL

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 : 1891786067
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EUGENE MANDREA M.D.
Provider Business Mailing Address
First Line : 7300 W COLLEGE DR
Second Line : 1NW
City : PALOS HEIGHTS
State : IL
Zip : 60463-1152
Country : US
Telephone Number : 708-671-1374
Fax Number : 708-671-1378
Provider Business Practice Location Address
First Line : 7300 W COLLEGE DR
Second Line : SUITE 1NW
City : PALOS HEIGHTS
State : IL
Zip : 60463-1152
Country : US
Telephone Number : 708-671-1374
Fax Number : 708-671-1378
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2005
Last Update Date : 01/11/2026

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1831110279 — MRS. BERNICE IK-JANG MI JOHNSON PHYISICAN ASSISTANT
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Practice Fax: 708-671-1378

Directions to “ DR. EUGENE MANDREA M.D.” Practice Location

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