Provider Demographics
NPI:1093993172
Name:WAGIH MANDO, M.D., FACS., LLC
Entity Type:Organization
Organization Name:WAGIH MANDO, M.D., FACS., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAGIH
Authorized Official - Middle Name:R
Authorized Official - Last Name:MANDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-464-8619
Mailing Address - Street 1:200 W ESPLANADE AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2489
Mailing Address - Country:US
Mailing Address - Phone:504-464-8619
Mailing Address - Fax:
Practice Address - Street 1:200 W ESPLANADE AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2489
Practice Address - Country:US
Practice Address - Phone:504-464-8619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1966312Medicaid
LA1966312Medicaid