Provider Demographics
NPI:1043213234
Name:MANGAT, BHUPINDER S (MD)
Entity Type:Individual
Prefix:DR
First Name:BHUPINDER
Middle Name:S
Last Name:MANGAT
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 1:1403 MEDICAL PLAZA DR
Mailing Address - Street 2:STE 204
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1047
Mailing Address - Country:US
Mailing Address - Phone:407-324-5500
Mailing Address - Fax:407-324-5584
Practice Address - Street 1:1403 MEDICAL PLAZA DR
Practice Address - Street 2:STE 204
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1047
Practice Address - Country:US
Practice Address - Phone:407-324-5500
Practice Address - Fax:407-324-5584
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2013-02-21
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
FLME34679174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371305900Medicaid
FL371305900Medicaid
FL05420Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE ID