Provider Demographics
NPI:1003804766
Name:MANGULABNAN, RAY PETER (MD)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:PETER
Last Name:MANGULABNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2022 MANCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48609-9220
Mailing Address - Country:US
Mailing Address - Phone:989-781-0140
Mailing Address - Fax:
Practice Address - Street 1:3170 HALLMARK CT
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2183
Practice Address - Country:US
Practice Address - Phone:989-790-1275
Practice Address - Fax:989-249-4199
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301072416207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7307374OtherAETNA US HEALTHCARE
MIN48190001OtherMEDICARE
1107304342OtherBCBS OF MI
0992071OtherHEALTH PLUS OF MI
4411167OtherMEDICAL SERVICES ADMIN
MI4411167Medicaid
7307374OtherAETNA
P25942FOtherBLUE CARE NETWORK
010683841050OtherCOMM CHOICE CARE SOURCE
0N48190OtherWISCONSIN PHYS SERVICES
MIMOLINAOtherQMXPR0027616
P25942FOtherBLUE CARE NETWORK