MEDICARE: DR. NARAYANAN K MANGALAT 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	208600000X	Surgery Physician	R7308	MO

General Provider Information

NPI Number	:	1922090299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NARAYANAN K MANGALAT M.D.

Provider Business Mailing Address
First Line	:	103 11TH ST
Second Line	:	SUITE #5
City	:	CHILLICOTHEE
State	:	MO
Zip	:	64601-1676
Country	:	US
Telephone Number	:	660-707-4472
Fax Number	:	660-707-4475

Provider Business Practice Location Address
First Line	:	103 11TH ST
Second Line	:	SUITE #5
City	:	CHILLICOTHEE
State	:	MO
Zip	:	64601-1676
Country	:	US
Telephone Number	:	660-707-4472
Fax Number	:	660-707-4475

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	12/01/2009

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