Provider Demographics
NPI:1003990870
Name:MANGURTEN, HOWARD SHELDON (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:SHELDON
Last Name:MANGURTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 GRAND CANYON PARKWAY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169
Mailing Address - Country:US
Mailing Address - Phone:847-884-8420
Mailing Address - Fax:847-884-0198
Practice Address - Street 1:990 GRAND CANYON PARKWAY
Practice Address - Street 2:SUITE 310
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169
Practice Address - Country:US
Practice Address - Phone:847-884-8420
Practice Address - Fax:847-884-0198
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31603504OtherBCBS
C41572Medicare UPIN
ILK37592Medicare PIN
IL920760Medicare PIN