Provider Demographics
NPI:1376632208
Name:MANDY, DAVID ROBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROBERT
Last Name:MANDY
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:46600 ROMEO PLANK RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-5741
Mailing Address - Country:US
Mailing Address - Phone:586-228-5437
Mailing Address - Fax:586-228-7520
Practice Address - Street 1:46600 ROMEO PLANK RD
Practice Address - Street 2:SUITE 4
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-5741
Practice Address - Country:US
Practice Address - Phone:586-228-5437
Practice Address - Fax:586-228-7520
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIDM006689208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE31570Medicare UPIN